Varicella Pneumonitis

The occurrence of widespread pulmonary infiltration involving all five lobes, without cavitation or calcification, suggests a number of possibilities to the radiologist. It is unlikely, however, that many would consider chickenpox. A case of extensive pneumonitis due to the varicella virus was seen recently and was thought worthy of publication after a search of the radiological literature revealed only two abstracts on the subject and no original papers or illustrations. Although chickenpox is regarded as the mildest of the various exanthematous diseases of childhood, it can produce serious illness and even death. The incidence of complications at the present time is not known, but before the days of sulfa and antibiotics was reported to be 5 per cent (1). Most of the complications listed were infectious in nature (otitis media, impetigo, septicemia, etc.) and would very likely be prevented today by prophylactic antibiotic therapy. Of Bullowa and Wishik's series of 2,534 cases of chickenpox (1), 21 were complicated by pneumonia, but there is no way of knowing how many of these were due to secondary invaders and how many to the varicella virus. Of the 8 fatal cases, all were shown microscopically to be due to secondary invaders, with no characteristic evidence of a virus pneumonia. In addition to this large series, 18 cases of varicella pneumonia have been reported (2-17) in the last fifteen years, 1940-55 (a period in which no case of pneumonia from secondary invaders should have occurred). Seven of these had a fatal outcome (3, 4, 5, 9, 11, 15. 16), with multiple organ system involvement present in each. The gastrointestinal tract, spleen, liver, kidneys, pancreas, and brain showed invasion by the virus in various combinations. Of these fatal cases, 1 occurred in a premature infant infected by transplacental transmission of the virus (11), 1 in a newborn baby infected during delivery (9), and 1 in a child of eight who also had rheumatic heart disease (15). The other patients were adults between thirty-two and seventy-one years of age (3, 4, 5, 16). Autopsy findings (3, 5, 8, 9, 11, 16) were quite similar from case to case and tissue to tissue: disseminated areas of necrosis in epithelial tissues, with predominantly mononuclear cell infiltration and intranuclear inclusion bodies in the epithelial cells. Grossly, the lungs showed patchy bronchopneumonia with the areas of consolidation tending to confluence but without suppuration. Of the patients who recovered, all were seriously ill. One of these (12) had severe laryngospasm, probably as a result of involvement of the larynx by “pock” lesions; 5 had hemoptysis, and 1 a hemorrhagic rash, these signs being more common in the fatal group. Several unusual complications were seen in this collected series.