Case presentation:
A 23-year-old male patient presented to the emergency department with a
complaint of high grade fever, chills and generalized rash for 5 days.
The patient was diagnosed with the end-stage renal disease 4 years ago
which he was put on routine hemodialysis program for 1 year. He
underwent renal transplant 3 years ago and since then he did not needed
any hemodialysis sessions. Following his renal transplant surgery the
patient was put under immunosuppressants drugs (mycophenolate mofetil,
steroids and tacrolimus). He had no known history of chickenpox at young
age, no history of diabetes. He never had any vaccination following his
renal transplant including varicella vaccine. There was no history of
contact with chickenpox patient.
On presentation, the patient was fully conscious, alert and co-operative
and with the following vital signs: BP 145/90 mmHg, pulse 90 times per
minute, RR 14 bpm, and temperature 38.6 °C. On examination, there was no
jaundice or anemic conjunctiva. He had no palpable lymph nodes,
discomfort, or stiffness in the neck. The rashes were variously healed
widespread erythematous papules and vesicles in the face and trunk
(Figure 1). Chest examination was within normal limit with no rales or
wheezing. He had normal bowel sounds on abdominal examination with no
organomegaly. Limb examination showed adequate turgor and no edema,
inguinal lymph nodes were not palpable. Blood tests revealed a
hemoglobin (Hb) level of 16.6 g/dl, hematocrit (Ht) 49.8%, leukocyte
7.60/mm3, platelet 200,000/mm3, MCV 87.9 fl, MCH 29.4pg, MCHC 33.4,
creatinine 0,82mg/dl, urea 34 mg/dl random blood glucose (RBS) 110mg/dl,
Sodium 142mEq/l, potassium 3,84mEq/l. Urine examination was
unremarkable. Abdominal ultrasonography only revealed bilateral atrophic
kidneys and transplanted kidney in the pelvic region.
The patient was admitted to infectious disease department under the
diagnosis of chickenpox infection using clinical assessment. He was
started with intravenous acyclovir 3x750mg for 5 days which was later
switched to oral acyclovir 5*800mg and acyclovir lotion and
antipyretics.
As his rash started subsiding with normal temperature he was discharged
to home with close monitoring. After 3 weeks the patient came for
follow-up his rashes had drastically improved and had no fever or chills
(figure 2).