Varicella Pneumonia in a 39-year-old Female in Third Trimester Twin Pregnancy
A 39 years old female smoker, in a high grade twin pregnancy, referred to Clinic for infectious diseases with five days history of illness. In a first two days she had a high temperature, up to 38.8oC, and later she noticed „vesicular“ rash, distributed mostly on head and torso. She visited general practicioner and specialist for infectious diseases, with suggestion to take symptomatic therapy. Before the admission in hospital her condition get worse, with fatigue, exhaustion, and shortness of breath. The patient did not have a history of chickenpox during childhood but her son developed chickenpox 10 days earlier. There was no past history of diabetes, cardiac or pulmonary disease.\nAt admittance the patient was febrile (39.2°C), tachypnoic (respiratory rate 30 breaths/min), tachycardic (cardiac pulse 110/min), pale and sweaty. She had typical chickenpox vesicles with some pustules over the face, neck, torso and abodmen. Peripheral lymphonodes were enlarged in neck area. Some vesicles were presented in oral mucosa. Pulmonary examination revealed billateral inspiratory crackles over the lung bases. Arterial blood gases indicated respiratory failure (oxygen saturation 83%). Blood tests show high C-reactive protein (CRP), normal leukocytes and differential blood count, with low platelets. In a first three days patient was febrile up to 39.3OC, tachydispnoic and ortopnoic, with bullosus rash over the trunk. Initially we started with intravenous therapy with acyclovir, cefepime and cloxacillin. Fourth day of hospital stay we noticed detoriation in patient’s condition, with intensive chest pain, bloody cough and intermittent disorientation and dominant tachypnea (over 40/min). Chest X-ray revealed infiltrative shadows in basal parts of lung. CT confirmed billateral infiltration with signs of alveolo-interstitial syndrome, with massive inflammatory changes. Antimicrobial therapy was changed to vancomycin and rifampicin, corticosteroids are associated (hydrocortison), with cardiotonic, diuretic, albumin infusions, pantoprasole, heparin and continuous oxygenation on facial mask. Significant improvement was noticed after five days of this therapy. Blood tests show normal CRP, platelets and WBC. Control chest X-ray revealed siginificant regression of infiltrative changes. Gynecologist indicated arteficial abruption of pregnancy. After 19 days of intesive care in our clinic, patient was transferred to Clinic for gynecology and obstretition where artefitial abrubtion has been completed.\nOn follow-up after 14 days patient was in good condition, with normal chest x-ray and blood tests.