69 Varicella-Zoster Pneumonia

CASE 69


image Clinical Presentation


53-year-old woman status post kidney transplant eight months earlier with five-day history of vesicular skin rash followed by progressive dyspnea, cough, tachypnea, and chest pain


image Radiologic Findings


PA (Fig. 69.1A) and lateral (Fig. 69.1B) chest radiographs show multiple subcentimeter nodules of varying size distributed throughout both lungs. Chest CT (lung window) (Figs. 69.1C, 69.1D, 69.1E, 69.1F) reveals 1–10 mm well-defined and ill-defined nodules randomly disseminated bilaterally. At least one nodule in the left lower lobe has surrounding ground glass (Fig. 69.1E). Note the absence of pleural effusion and lymphadenopathy.


image Diagnosis


Varicella-Zoster Pneumonia


image Differential Diagnosis


• Cytomegalovirus (CMV)


• Adenovirus


• Measles


• Respiratory Syncytial Virus (RSV)


• Disseminated Fungal Pulmonary Infection


Mycobacterium tuberculosis


• Metastatic Pulmonary Disease


image Discussion


Background


Varicella-zoster virus (VZV) is a contagious herpes virus that can cause two distinct clinical syndromes. The first, varicella (chickenpox), is most commonly a self-limited mucocutaneous process that occurs primarily in children, and less often in adults. The second, herpes zoster (shingles

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Jan 14, 2016 | Posted by in RESPIRATORY IMAGING | Comments Off on 69 Varicella-Zoster Pneumonia

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