Varicella Development after Infliximab Therapy for Refractory Pouchitis in Post-surgical Ulcerative Colitis

A boy in his late teens had undergone proctocolectomy for refractory ulcerative colitis eight months ago. Two months earlier, he had developed pouchitis and received intensive treatment with infliximab (IFX). Two days after the IFX injection, a fever and generalized rash appeared. Varicella zoster virus (VZV) antigen positivity in the blisters led to a diagnosis of varicella. Based on the history of VZV vaccination, environmental conditions, and VZV antibody titers in the early stages of the disease, VZV reactivation was suggested. The possibility of varicella should be considered when blisters occur in immunosuppressed patients, although this is rare.