A 21-day-old girl was brought to us with hemorrhagic skin
lesions (Fig. 1,2), epistaxis, melena and
hepatomegaly. Her mother developed varicella 4 days prior
to delivery. The Baby was asymptomatic till 10th day of life
when she developed vesicular skin eruptions which progressed
to become hemorrhagic. The baby was kept in isolation and
treated with intravenous acyclovir 10 mg/kg/day thrice a day
for 14 days along with ampicillin and cloxacillin. The
coagulation profile, liver function tests and chest X-ray
were normal. The baby was discharged on 30th day of life.
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Fig. 1 Hemorrhagic
varicella with centrifugal distribution.
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Fig. 2 Blisters with
hemorrhage and excoriation.
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Peri-partum infection of fetus before
sufficient maternal antibodies has crossed the placenta (<5
days or >2 days of delivery) results in severe varicella.
Progressive varicella syndrome is a dreaded complication in
neonates, immuno-compromised and pregnant women. It presents
with continued development of multiple hemorrhagic lesions
and complications like coagulopathy, hepatitis, pneumonitis
and encephalitis.
