2000 Associates' Presentations
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Varicella Pericarditis

Joaquin Solis, MD, Medical College of Wisconsin, Milwaukee, WI

Educational Objective: Recognize complications of Varicella infection in the adult.

Case: A 21-year-old African American male was diagnosed with Varicella one week prior to presenting to the emergency department. He was complaining of fever, generalized myalgia and neck rigidity. Lumbar puncture as well as CXR done in ER were both completely normal and he was discharged home with supportive care. Two days later he presented with severe chest pain and shortness of breath. He was found to be in respiratory distress, febrile, tachycardic with a loud pericardial friction rub. His skin showed multiple disseminated crusted lesions. Chest roentgenogram showed bilateral interstitial infiltrates as well as an increase in cardiac silhouette. An echocardiogram confirmed the presence of moderate pericardial effusion with normal left ventricular function and no evidence of tamponage. A diagnosis of Varicella pneumonia with Pericarditis was made on bases of clinical findings and viral titers. Repeat echocardiogram day 5 showed no change. The patient required mechanical ventilation due to respiratory failure and ARDS. Ten days after admission to the ICU he developed pericardial tamponage and despite aggressive supportive measures including pericardiocentesis succumbed.

Discussion: Cardiac complications from Varicella include acute pericarditis, myocarditis and arrythmias but are exceedingly rare. They appear in teenagers and young adults and it has been linked to other complications as pneumonia or arthritis. Acute pericarditis has been described few times in the literature associated with superimposed Staph infections. It generally has a benign course if myocarditis or pericardial effussion are not present. When associated with myocarditis, manifestations may range from arrhythmias to fulminant cardiac failure and/or cardiac tamponade. Though rare, adults with Varicella who clinically deteriorate, should be evaluated for cardiac complications, especially if pneumonia or arthritis are present.

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