Varicella pneumonia in adults: a spectrum of disease

Varicella (Chicken pox) is a contagious disease common in childhood but uncommon in adulthood. Pneumonia, however, is a relatively common complication of the disease in adults. Recognition of the potential for this complication in adult patients with varicella is essential for the emergency physician. Three cases of varicella pneumonia in adults are presented, representing the spectrum of disease. The first patient was a 58-year-old man without respiratory complaints who was managed successfully as an outpatient. The second patient was a 24-year-old woman who progressed from mild to marked respiratory distress over several hours, and was treated successfully with high-flow oxygen alone. The third patient was a pregnant 23-year-old woman who presented without respiratory symptoms but rapidly developed adult respiratory distress syndrome, resulting in death. Clinical assessment, patient management, and indications for hospitalization are discussed.