Disseminated Varicella with Visceral Involvement in an Immunocompromised Adult
Disseminated Varicella with Visceral Involvement in an Immunocompromised Adult - Infectious Diseases clinical simulation case. A 54-year-old...
Age: 54 • Gender: Male • Setting: Emergency Triage
Clinical Presentation & History
A 54-year-old immunocompromised man presents to the resuscitation bay with a 36-hour history of a rapidly spreading umbilicated vesicular rash involving the trunk, face, and extremities, accompanied by fever to 39.8°C and severe diffuse abdominal pain out of proportion to examination findings. His wife reports a known exposure to a grandchild with active varicella infection approximately three weeks ago.
Acute Resuscitation Milestones & Priorities
Clinical phases and key interventions encountered in this emergency module:
Definitive ICU Disposition & Public Health Notification
High-Yield Clinical Pearls
Disseminated varicella in immunocompromised hosts is a clinical emergency requiring empirical IV acyclovir at 10–15 mg/kg every 8 hours, renally adjusted, before confirmatory PCR results.
Airborne plus contact isolation in a negative-pressure room is mandatory until all lesions are crusted; VZV is one of the most contagious nosocomial pathogens.
Visceral involvement — hepatitis (rising transaminases, INR elevation), pneumonitis (hypoxemia, ground-glass opacities), and DIC (schistocytes, low fibrinogen, high D-dimer) — must be actively sought in any immunocompromised patient with diffuse varicella rash and abdominal pain.
VariZIG provides passive immunity and should be administered early in immunosuppressed contacts of primary varicella cases.
Diagnostic stewardship: avoid empiric antibacterial or antifungal coverage that does not address the viral etiology and risks additional nephrotoxicity in patients with baseline CKD.
Test Your Clinical Reasoning in Real Time
Step into the active clinician role for this case. Order diagnostic tests, analyze live laboratory panels, and navigate branching clinical decisions with real-time feedback.