Acute Facial Swelling

Photoclinic: Varicella-Zoster Infection

By Tom Nichols, MD

A 9-year-old girl was hospitalized because of a painful, vesicular rash on her genitals, groin, and buttocks. There was also concern about possible genital herpes infection in a minor.

Before admission, the patient had experienced symptoms of viral upper respiratory tract infection for 5 days. She also had a 2-day history of fever, severe headache, and painful rash on the labia, inner thigh, anus, and buttocks. The rash was primarily left-sided. She had previously been healthy.

The patient had had chickenpox when she was 2 years old. The patient and family denied sexual abuse. None of the family members had a history of cold sores or genital herpes.

Because of the vesicular rash, therapy with intravenous acyclovir was started in the inpatient pediatric unit, writes Tom Nichols, MD, of the Children's Hospital of Wisconsin-Fox Valley in Neenah, Wis.Social Services was consulted. A day after admission, the patient's symptoms and rash had diminished.

Several vesicles were lanced and a DNA polymerase chain reaction (PCR) test was performed on the fluid to evaluate for varicella-zoster and herpes simplex virus infection. Test results proved to be positive for varicella-zoster infection.

The mechanism by which varicella-zoster virus becomes reactivated is unknown. In children, however, there are several recognized risk factors for reactivation. These include in utero varicella exposure, immunocompromise, acute lymphocytic leukemia and other malignancies, and primary varicella-zoster infection during the first year of life.1