Chickenpox in an Adult

A 30-year-old man presented with a few-day history of a viral prodrome, including a low-grade fever, mild headache, muscle and joint aches, and malaise, accompanied by a vesiculopapular rash. The mildly pruritic eruption began on the head and neck and progressed within 36 hours to the trunk and proximal extremities; the palms and soles were spared. The patient did not recall having had chickenpox earlier in life; however, the disease had developed in his young nephew shortly after a family reunion several weeks earlier. The constitutional symptoms and the distribution and appearance of the rash (clear vesicles on an erythematous base, or so-called dewdrops on a rose petal) led to the diagnosis of chickenpox, or varicella. Fewer than 5% of adults contract the disease; 90% of those affected are younger than 15. Typically, disease severity varies, but morbidity is greater among adults and the risk of complications, such as pneumonia, is increased. To lessen the severity of symptoms and reduce the risk of complications, valacyclovir was given to this patient. Famciclovir(is another option in this setting. (Case and photograph courtesy of Dr David L. Kaplan.)