A 54-year-old man was admitted to ICU for respiratory failure. He had no past medical history except tobacco and cannabis use. He had a 2-day history of increasing dyspnea. Oro-tracheal intubation was immediately performed and moderate acute respiratory distress syndrome (ARDS) was confirmed by chest X-ray (Fig. 1a), a PaO2/FiO2 ratio of 170 and the absence of heart failure assessed by trans-thoracic echocardiography. The patient also presented vesicular cutaneous eruption on the whole body involving mucosa (Fig. 1b). Varicella pneumonia was confirmed thanks to positive Varicella-Zoster Virus PCR on broncho-alveolar lavage and blood as well as positive serology (IgM). Serology for Human Immunodeficiency Virus was negative. The treatment consisted in acyclovir for 15 days and a 18-day long intubation but the patient finally recovered. Varicella pneumonia mostly occurs during a VZV primo-infection in adulthood and can provoke an ARDS even among immunocompetent patient as described here.
Fig. 1.
a Chest X-ray revealing a bilateral diffuse alveolar and interstitial infiltrates. b Diffuse vesicular cutaneous eruption with different ages lesions
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