Adult primary varicella pneumonia: high-resolution computed tomography findings

The Efficacy of Amenamevir for the Treatment of Disseminated Herpes Zoster Complicated with Probable Varicella-zoster Pneumonia in an Immunocompromised Patient

We herein report the case of a 78-year-old woman who was diagnosed as having disseminated herpes zoster (DHZ) complicated with probable varicella-zoster pneumonia during maintenance therapy for microscopic polyangiitis. Because the patient had severe renal dysfunction, amenamevir administration was started to avoid any neurotoxicity of acyclovir, which is suggested to be optimal for treatment. It ameliorated her symptoms without any adverse events. This is the first report suggesting the efficacy of amenamevir in the treatment of severe herpes zoster infection with coexisting DHZ and probable varicella-zoster pneumonia. Amenamevir could thus be a treatment option for severe varicella zoster virus infections.

Healed Varicella Pneumonia: A Case of Diffuse Pulmonary Microcalcifications

Varicella pneumonia is a potentially fatal complication of the Varicella-zoster virus (VZV), which causes the well-known chickenpox disease of childhood. Identifying this type of pneumonia by characteristic features is important for radiologists and radiology residents. Typical manifestations of active Varicella pneumonia include diffuse pulmonary nodules, which may mimic other diseases. Healed Varicella pneumonia can present as diffuse, calcified pulmonary micronodules. We describe a case of healed Varicella pneumonia in a patient with a history of remote VZV infection.

Diffuse pulmonary micronodules related to prior VZV infection

Background/introduction

Chickenpox is a common viral infection caused by Varicella-zoster virus (VZV). Pneumonia is an infrequent complication of chickenpox infection. Rarely, multiple calcified pulmonary nodules can be the sequela of healed VZV pneumonia.

Case presentation

A middle-aged female individual was found to have diffuse incidental pulmonary micronodules. By further history inquiry and diagnosis of exclusion, her pulmonary micronodules were determined to be likely associated with prior VZV infection.

Conclusions

VZV infection can cause calcified pulmonary nodules related to granuloma, and gold standard diagnosis is surgical lung biopsy with VZV PCR. However, diagnosis of exclusion is a reasonable approach to reach a presumptive diagnosis. Familiarity with this entity can potentially avoid invasive procedures in selected patients.