Chickenpox in an Adult

A 30-year-old man presented with a few-day history of aviral prodrome, including a low-grade fever, mild headache,muscle and joint aches, and malaise, accompaniedby a vesiculopapular rash. The mildly pruritic eruptionbegan on the head and neck and progressed within 36hours to the trunk and proximal extremities; the palmsand soles were spared.The patient did not recall having had chickenpoxearlier in life; however, the disease had developed in hisyoung nephew shortly after a family reunion severalweeks earlier.The constitutional symptoms and the distributionand appearance of the rash (clear vesicles on an erythematousbase, or so-called dewdrops on a rose petal) led tothe diagnosis of chickenpox, or varicella. Fewer than5% of adults contract the disease; 90% of those affected areyounger than 15. Typically, disease severity varies, butmorbidity isgreater amongadults and therisk of complications,such aspneumonia, isincreased.To lessenthe severity ofsymptoms andreduce the riskof complications,valacyclovir wasgiven to this patient.Famcicloviris another optionin this setting. (Case and photographcourtesy ofDr David L. Kaplan.)