Discussion
Diagnosis With Brief Discussion
- Diagnosis
- Varicella-zoster pneumonia
- Radiologic Findings
- Initial chest plain radiograph shows multiple nodular patchy infiltration in both lungs, especially at LLLF.
Serial non-contrast chest CT scan demonstrated multiple randomly distributed small sized, ill-defined nodules with surrounding halo of ground-glass opacity in both lungs. Focal ill-defined GGO/consolidation in the LUL lingula division.
The patient showed skin rash as shown as figure, and serum IgM of Varicella-zoster was positive. After treating with IV acyclovir 10mg/kg for 4 days and PO gangiclovir for 3 days, symptom and chest plain radiograph of the patient was much improved.
- Brief Review
- Varicella virus (varicella-zoster virus) is a double-stranded DNA virus and a member of the Herpesviridae family. Varicella (chickenpox) is a common contagious infection in childhood, with increasing frequency in adults . Pneumonia, although rare, is the most serious complication affecting adults with chickenpox. Varicella pneumonia is estimated to occur in one of every 400 cases of adulthood chickenpox infections, being more common in pregnant and immunosuppressed patients .
Predisposing conditions include underlying leukemia and lymphoma and other causes of immunodeficiency. Patients with human immunodeficiency virus or acquired immunodeficiency syndrome (AIDS) with chickenpox are at high risk for developing varicella pneumonia .
Symptoms of pneumonia develop within a few days after the skin rash appears and include cough, dyspnea, hemoptysis, tachypnea, pleuritic chest pain, cyanosis, and fever. Analysis of case series suggests that mortality due to varicella pneumonia has declined with the advent of acyclovir, although it remains as high as 22% in immunocompromised hosts.
The thin-section CT appearances in varicella pneumonia largely reflect the multicentric hemorrhage and necrosis centered on airways . Common findings include numerous nodular opacities measuring 5
- References
- 1. Tomas Franquet, Imaging of pulmonary viral pneumonia, Radiology 2011; 260:18
- Please refer to
- Case 79 Case 328 Case 917
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- Keywords
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Lung, Viral infection,