A case of fatal severe chickenpox in a patient with a kidney transplant

Infection caused by the Varicella zoster virus (VZV) is a significant problem for immunocompromised individuals such as patients receiving immunosuppressive therapy, patients with immunodeficiency or HIV infection. Most often, VZV infection in this group of patients represents a reactivation of chronic infection, in the form of herpes zoster with a possible generalization. However, primary infection is also possible with the development of chickenpox, which is often severe, and with the development of complications leading to death. The article represents a clinical case of severe chickenpox complicated by the development of sepsis and subsequent death in an adult patient with a kidney transplant on the background of immunosuppressive therapy. The disease proceeded atypically, with a four-day prodromal period and further rapid development of the clinical picture with the simultaneous presence of manifestations of typical, hemorrhagic, and visceral forms of chickenpox. The spread of the rash was also atypical - mainly on the head, upper extremities, and upper trunk. On the scalp and face the elements were represented by vesicles and pustules, and from the neck to the umbilical region - in the form of vesicles with hemorrhagic contents. Secondary bacterial infection of the rash elements was joined on the 3rd day from the appearance of the rash with the further development of the septic condition. The diagnosis was confirmed by PCR of the contents of the pustules and the absence of IgG class antibodies to the Varicella zoster virus. The generalization of secondary bacterial infection was confirmed by seeding the same pathogens in the contents of pustules and urine. Against the background of ongoing therapy, which included the use of acyclovir and massive antibacterial therapy, the patient's condition continued to deteriorate, and on the 9th day from the disease onset, a fatal outcome occurred. This clinical case demonstrates the possible difficulties in the diagnosis and management of chickenpox in immunocompromised patients, and emphasizes the need to develop and implement preventive measures for this cohort of patients.

ветряная оспа, Varicella zoster, иммунокомпрометированные пациенты, трансплантация почки, иммуносупрессивная терапия, chickenpox, Varicella zoster, immunocompromised patients, kidney transplant, immunosuppressive therapy

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