Infantile Varicella with Acute Kidney Injury – A Child with Immunodeficient Mother

Madam, We present a case of an 11-month-old male child born to a mother with HIV and a history of tuberculosis infection. The child presented with a history of diarrhea, shortness of breath, fever, and vesicles on the face, extremities, and trunk. On examination, vesicles on an erythematous base, with a few very tiny crusts and exfoliation, were seen. Lesions had crusted on the lips [Figure 1]. The infant's delivery history was uneventful. Due to respiratory distress, he was immediately transferred to the intensive care unit. Laboratory data showed leukocytosis, thrombocytopenia, low hemoglobin levels, elevated level of liver transaminases, and deranged renal parameters. The child had acute kidney injury. HIV status and viral markers were nonreactive. Antiviral treatment with acyclovir (dose adjusted based on the patient's renal function calculated as estimated glomerular filtration rate = 36.5 × height in cm/88.4 × creatinine [mg/dL]) was initiated along with cephalosporins (for superadded infections and raised C-reactive protein) and supportive therapy. The patient showed improvement on day 3 and was shifted to the ward [Figure 2]. He was discharged on day 5 and has been on regular follow-up since then. The case highlights the severity of varicella in immunosuppressed individuals and how it can manifest with significant organ malfunction.Figure 1: Vesicles on an erythematous base, with few very tiny crusts and exfoliation. Crusts on the lipsFigure 2: Post TreatmentVaricella is a highly contagious disease caused by the varicella zoster virus. It primarily affects children between the ages of 1 and 14 years and can be spread through direct contact or airborne droplets. Varicella is not common in the first year of life (infant varicella) and there is a lack of data on its presentation.[1] While the illness is usually mild in healthy children, it can be more severe in newborns and individuals with weakened immune systems. Complications from varicella are rare in healthy children, but can occur in 5%–10% of patients and most commonly affect the skin, nervous system, and respiratory system. The complications can include neurological problems such as cerebellar ataxia and encephalitis, as well as respiratory issues like pneumonia and upper respiratory tract infections.[2] In newborns, varicella can be transmitted from the mother to the baby during the last few weeks of pregnancy. In some cases, infants born to mothers who developed chickenpox just before or after giving birth can develop a severe form of the disease that can be fatal.[3] According to the World Health Organization, severe complications of varicella result in over 4 million patients requiring hospitalization worldwide each year.[4] This case report exemplifies the potential progression of a common disease like varicella in a previously healthy infant with a history of immunosuppression in the mother. It emphasizes the importance of prompt diagnosis, appropriate treatment, and supportive care in managing severe cases of varicella. Antiviral therapy and appropriate supportive treatment improve infantile outcomes. Declaration of patient consent The authors certify that they have obtained all appropriate consent forms, duly signed by the parent(s)/guardian(s) of the patient. In the form, the parent(s)/guardian(s) has/have given his/her/their consent for the images and other clinical information of their child to be reported in the journal. The parents understand that the names and initials of their child/children will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.