Neck Abscess as a Rare Sequela of Pediatric Varicella-Zoster Infection: A Case Report

Chickenpox is caused by the varicella-zoster virus (VZV), a DNA virus of the herpes virus family. While typically mild and self-limiting, it poses a high risk of contagion. A generalized pruritic rash is the common initial symptom among pediatric populations. Complications often include bacterial infections of skin lesions, predominantly staphylococcal or streptococcal, which may progress to cellulitis or bullous impetigo. Additionally, it may lead to more severe complications such as cerebellar ataxia, encephalitis, viral pneumonia, hemorrhagic conditions, and joint involvement. We present a case of a 17-month-old male diagnosed with varicella-zoster infection a week prior. His presentation included diffuse swelling in the left neck, accompanied by fever and reduced oral intake. Clinical and radiological assessments confirmed a left neck abscess with multiple cervical lymphadenitis. Following the incision and drainage of the abscess, the patient achieved complete resolution of symptoms with antimicrobial treatment. To the best of our knowledge, this is the first reported case of pediatric varicella-zoster infection complicated by a secondary bacterial skin infection leading to a neck abscess. It underscores the importance for clinicians to perform comprehensive evaluations in patients manifesting secondary skin lesion infections. Early referral to tertiary care facilities is imperative, as neck abscesses, albeit rare, necessitate prompt treatment to avert potential complications.