69 Varicella-Zoster Pneumonia

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

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.

Diagnosis

Varicella-Zoster Pneumonia

Differential Diagnosis

• Cytomegalovirus (CMV)

• Adenovirus

• Measles

• Respiratory Syncytial Virus (RSV)

• Disseminated Fungal Pulmonary Infection

• Mycobacterium tuberculosis

• Metastatic Pulmonary Disease

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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