Atypical, severe presentation of chickenpox

Excerpt

A previously well 5-year-old boy presented with a 4-day history of fever (39.2 °C) and spreading rash. His elder sister was diagnosed with a typical chickenpox two weeks earlier. The rash consisting of vesicles initially started on his head and spreaded to his body and limbs. On the third day of this illness, large erythematous maculopapular elements appeared on his left ear and lower legs and progressed into bullae 3–4 cm in diameter. Over the night, large eroded bullae were found on his inner thighs (Fig. 1a), body and upper limbs. Enzyme-linked immunosorbent essay performed on day 4 after the rash onset was positive for specific type 3 Varicella Zoster antibodies. Bacteriological examination of the bullae contents was negative. The patient was started on acyclovir. Healing of skin lesions occurred by day 11 of the disease (Fig. 1b). Bullous forms most frequently result from co-infection with S. pyogenes and S. aureus. [1]. In the present case, no evidence of bacterial co-infection was found.

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