Bullous varicella in an immunocompetent infant

• Published in: BMJ case reports Vol. 12; no. 3; p. e229025
• Main Authors: Mansouri, Siham, Mai, Sara, Hassam, Badr, Benzekri, Laila
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01-03-2019; BMJ Publishing Group
• Subjects: Bacterial infections; Case reports; Chicken pox; Dermatology; Herpesvirus 3, Human; Humans; Images In; Immunocompetence; Infant; Infections; Male; Pediatrics; Penicillin; Skin Diseases, Vesiculobullous - virology; Skin Diseases, Viral - virology; Vaccines; Varicella Zoster Virus Infection - virology; United States > US; Montana; paediatrics; dermatology; infectious diseases
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2018-229025

Correspondence to Dr Siham Mansouri, [e-mail] Description A Moroccan 6-month-old boy with no known medical problems or previous drug intake, was admitted to the paediatric department with a 2‐week history of high‐grade fever with subsequent eruption of multiple bullous lesions on the entire body, unsuccessfully treated with amoxicillin and clavulanic acid for 10 days. The most frequent cutaneous complication of varicella is bacterial surinfection, caused often by Staphylococcus aureus or Streptococcus pyogenes, which can accentuate the scarring and rarely lead to staphylococcal and streptococcal toxic shock syndromes.2 A severe form of cellulitis and necrotising soft tissue infection has been reported following varicella which are caused by strains of group A β-haemolytic streptococci. Other cutaneous complications of varicella include haemorrhagic varicella and purpura fulminans.2 Bullous onset of chickenpox as seen in our case is an extremely rare manifestation which is more commonly seen in immunocompromised children contrarely to our patient who was immunocompetent.2–6 The exact mechanisms by which large bullae are formed are not clear, some synergistic effect between the infectious agents must occur.