[Varicella associated necrotizing fasciitis in a child]. / Varizellenassoziierte nekrotisierende Fasziitis beim Kind.

We present a rare case of necrotizing fasciitis in an 5-year-old infant with preexisting varicella infection. Initially, the patient showed acute pain and swelling of the left thorax with high inflammatory parameters and varicella-specific skin affections. MRT presented diffuse soft tissue swelling of the left chest consistent with necrotizing fasciitis. After aggressive surgical debridement of necrotic tissue and extirpation of axillary lymph nodes, the clinical course improved under appropriate parenteral antimicrobial therapy using penicillin and clindamycin. In conclusion, necrotizing fasciitis should be suspected in any child with a history of varicella infection and increasing complaints of pain and swelling in an extremity or other body area associated with increasing fever, erythema, lethargy, and irritability. Shock, multiorgan failure, and death will ensue if the diagnosis is not promptly recognized.

Postvaricella angiopathy: report of a case with pathologic correlation.

Varicella is a common childhood illness, and central nervous system complications occur frequently. Delayed angiopathy has been described, although there are few reports of clinicopathologic correlation. A previously well 4-year-old male is presented. He suffered varicella 2 months before presentation with extensive right middle cerebral artery (MCA) territory infarction. Cerebral angiography demonstrated an isolated 89% stenosis of the right proximal MCA. He developed cerebral edema refractory to medical treatment and progressed to transtentorial herniation. Right frontal temporoparietal craniotomies were performed with evacuation of infarcted brain tissue. Pathologic studies revealed small vessel vasculitis with lymphocytic infiltration of the vessel wall. Areas of demyelination were present within the white matter. Polymerase chain reaction for varicella was negative on brain tissue. Postvaricella angiopathy, although an uncommon complication, may affect both small and large blood vessels, with catastrophic results.

Periorbital varicella gangrenosa necessitating orbital exenteration in a previously healthy adult.

A previously healthy 31-year-old man had profound neurologic compromise and necrotizing periorbital infection due to a complication of varicella infection. Despite aggressive treatment, he required orbital exenteration and radical debridement of the involved tissues. He survived in a vegetative state for almost 1 year before succumbing to progressive neurologic deterioration. We present and discuss this complicated case of varicella gangrenosa to show the devastating nature of complications that can occur from varicella infection in the unsensitized adult.

Congenital varicella of the upper limb. A preventable disaster.

Two patients with a rare form of congenital varicella involving the upper limb are described. The spectrum of disease, pathophysiology, principles of management and prevention are discussed.