Neonatal varicella: a rare case

Abstract

Introduction: Varicella-zoster virus (VZV) infection in pregnant women in the last three weeks of pregnancy or the days before delivery causes neonatal varicella. It is rare in newborns and infants due to passive immunity received from the mother. Thus we report a rare case of neonatal varicella for an educational purpose. Case report: A 14-day-old girl was referred to the Department of Pediatrics with a red rash all over her body. The red rash begins on the face and subsequently spreads across the body fever for four days before the appearance of the rash. During the third trimester of pregnancy, the patient’s mother had varicella. The patient was delivered vaginally by the midwife at full term, weighing 3,400 g. Macules, papules, pustules, and vesicles, multiple in number, distinct, miliary to guttate in size, and universal distribution, were identified on physical examination in the facial, thoracic, and upper extremities region et inferior bilaterally. The Tzank test found multinucleated giant cells. Skin biopsy found stratum spinosum edema with powdered lymphocyte inflammatory cells (typical for varicella). Treatment with intravenous acyclovir showed improvement after 5 days. Conclusion: VZV generates a wide spectrum of clinical symptoms in the fetus and newborn and can be a life-threatening condition. Early recognition of pregnant women and newborns who are at risk for VZV infection is very necessary so that prophylaxis and treatment can be started immediately.