Fatal varicella in steroid-dependent asthma

Area of Science:

• Immunology
• Pulmonology
• Infectious Diseases

Background:

• Chronic high-dose corticosteroid (CS) therapy is associated with life-threatening disseminated varicella infections.
• CS-dependent asthma patients are generally considered low-risk for this complication, with few documented cases.
• This case highlights a potential underestimation of risk in severe asthma patients on immunosuppressants.

Observation:

• A 16-year-old steroid-dependent asthma patient developed disseminated varicella after CS treatment and chickenpox exposure.
• The patient presented with rash, hepatic failure, pneumonitis, and encephalopathy.
• Autopsy confirmed widespread varicella-zoster virus infection.

Findings:

• Disseminated varicella occurred in a CS-dependent asthma patient, contradicting previous literature.
• High-dose CS therapy in severe asthma may create a unique high-risk group for varicella complications.
• Rapid progression to multi-organ failure and death occurred within days of rash onset.

Implications:

• Severe asthma patients on high-dose CS require varicella-zoster virus immune status assessment.
• Non-immune patients should be considered for varicella-zoster immune globulin prophylaxis upon exposure.
• Acyclovir therapy is recommended if varicella dissemination occurs in this vulnerable population.