Disseminated chickenpox with multi-organ failure in an immunocompetent adult. a case report and literature review

BACKGROUND: Disseminated varicella infection in adults, particularly those with mild immunosuppression, can lead to severe complications and life-threatening outcomes. Early diagnosis and intervention are critical yet challenging due to atypical presentations. CASE PRESENTATION: A previously healthy 26-year-old male presented with severe epigastric and right upper quadrant abdominal pain radiating to the back, nausea, loss of appetite, and constipation. He had been taking oral prednisolone 5 mg daily for 2 weeks prior to symptom onset. Initial evaluation showed mild liver enzyme elevation but normal imaging studies. Within two days, he developed widespread vesicular lesions consistent with varicella, rapidly progressing to fulminant hepatic failure, disseminated intravascular coagulation (DIC), acute renal failure, and acute respiratory distress syndrome (ARDS). Despite intensive management including antiviral therapy, antibiotics, supportive transfusions, and mechanical ventilation, the patient unfortunately passed away due to multi-organ failure. CONCLUSION: This case emphasizes the importance of early suspicion and diagnosis of varicella infection in adults presenting with atypical symptoms, even low-dose steroid therapy may cause sufficient immunosuppression to predispose individuals to disseminated viral infections. Timely intervention can significantly influence patient outcomes.