Complicated Varicella Infection at 8-year-old Boy with Pulmonary Agenesis
The case presents a boy, aged 8 years, hospitalized with the clinical picture of complicated chickenpox. From history of disease: Disease begun 8 days before admission, manifested with fever and characteristic varicella rash. Two days before admission to hospital he complained on pain under right rib arch and intensive cough, otogenic secretion also was noted. In previous history he has been often treated for obstructive bronchitis. After admission he became tachydispnoic, with high fever, tachycardia, hypotensive, with positive auscultatory finding on the lung indicating pneumonia. Extremely high values of nonspecific parameters of inflammation: SE 108/ I hour, CRP 301 mg/l, L 18.5 10 9/L, fibrinogen 7.9 indicated bacterial infection. In other laboratory findings it was registered elevation of AST 196, ALT 297, with signs of hypoxemia. Patient was treated by combined antimicrobial treatment (initially vancomycin and imipenem, as well as antiviral treatment with acyclovir together with other supportive treatment. Due to extensive empyema in right hemithorax thoracocenthesis was performed and about 600 ml of purulent fluid was evacuated. Etiology of bacterial infection was not confirmed. Disease was complicated by further progression of MODS, treated by multidisciplinary approach in Intensive care unit. Disease had a favorable outcome without sequels, but congenital agenesis of right lower lobe and transposition of brachiocephalic trunk were discovered.