Pleural and lung complications of chickenpox in the immunocompetent adult

Varicella [chickenpox] is a common, contagious and usually benign infection in childhood nevertheless, in adulthood, it's uncommon, severe and usually associated to a high mortality rate. Varicella pneumonia is the most common and fatal complication of this infection in adults. However, pleural involvement is exceptional. We report the case of an immunocompetent adult patient presenting with fever, right chest pain, cough, shortness of breath and vesicular cutaneous disseminated rash, suggestive of varicella infection. Chest radiograph revealed interstitial left lung pneumonia associated with a total right pneumothorax. Serum sample varicella-zoster was positive to Ig G. A high dose venous acyclovir treatment with pleural drainage were effective, with improvement of clinical signs, healing of vesicular rash and reexpansion of the right lung. Varicella pneumothorax, contrarely to varicella pneumonia, is an extremely rare complication of chikenpox, and should be ruled out by chest x-ray examination if a patient with chickenpox develops a sudden chest pain or shortness of breath