Varicella complicated by erysipelas in an infant

Faical Kouskous1, Widade Kojmane1, Noura Kalmi2, Hanane Baybay2, Fatima Zahra Mernissi2, Moustapha Hida1

1Pediatrics Department, University Hospital Hassan II, Fes, Morocco, 2Department of Dermatology, University Hospital Hassan II, Fes, Morocco

Corresponding author: Faical Kouskous, MD, E-mail: kouskous.faical@gmail.com

How to cite this article: Kouskous F, Kojmane W, Kalmi N, Baybay H, Mernissi FZ, Hida M. Varicella complicated by erysipelas in an infant. Our Dermatol Online. 2024;15(e):e34.
Submission: 21.02.2024; Acceptance: 31.05.2024
DOI: 10.7241/ourd.2024e.34

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© Our Dermatology Online 2025. No commercial re-use. See rights and permissions. Published by Our Dermatology Online.


A 8-month-old infant presented one week prior to consultation with a febrile flare-up. It started with small red spots on the chest and face, then progressed to the face and legs with the appearance of small blisters that became umbilicated and then evolved into scabs. The patient was given ibuprofen for a fever. 48 hours later, he developed painful swelling and redness in the left lower limb (Fig. 1a). On physical examination, he presented with a fever of 40 degrees, an exanthema with lesions in various stages compatible with the diagnosis of chickenpox, and erythema and edema of the entire left limb extending to the inguinal fold, with no other signs of severity, notably no necrosis, phlyctenes, or purpura (Fig. 1b). Blood tests showed an elevated C-reactive protein level of 300, leukocytosis of 20000, and a normal CPK level. The diagnosis of erysipelas was therefore accepted, and the patient was put on antibiotics with good results.

Figure 1: (a) Varicella lesions on limbs; oedematous erythematous patch on left lower limb. (b) Erythematous,edematous placard over the entire left lower limb centered by varicella lesions.

Varicella is generally considered a benign and self-limited disease in children, manifested by a characteristic rash that has a cephalocaudal evolution, mild systemic symptoms, and a moderate fever. Bacterial superinfection is the most frequent serious complication of varicella virus infection, and chickenpox is a major risk factor for invasive group A streptococcal disease. Several complications secondary to chickenpox have been described, including infection of the skin and subcutaneous fat tissue [1].

Other possible complications of chickenpox include bone and joint infections, Reys’ syndrome, pneumonia, cerebellar ataxia, ischemic stroke, acquired protein S deficiency with purpura fulminans, and venous thrombosis, which are most often explained by the use of non-steroidal anti-inflammatory drugs. Consequently, fever and pain associated with chickenpox or herpes zoster should be treated with paracetamol, not non-steroidal anti-inflammatory drugs [2].

Consent

The examination of the patient was conducted according to the principles of the Declaration of Helsinki.

REFERENCES

1. Gershon AA, Breuer J, Cohen JI, Cohrs RJ, Gershon MD, Gilden D, et al. Varicella zoster virus infection. Nat Rev Dis Primers. 2015;1:15016.

2. Mrabat S, Baybay H, Douhi Z, Elloudi S, Mernissi FZ. A case of varicella complicated with erysipelas. Our Dermatol Online. 2020;11:107.1.

Notes

Source of Support: This article has no funding source.

Conflict of Interest: The authors have no confl ict of interest to declare.

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