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Clinical Case Study (Poster Session)

(P24-009-25) Varicella With Septic Shock in a Failure-to-Thrive Neonate: The Crucial Role of Early Diagnosis and Timely Intervention

Monday, June 2, 2025
11:45 AM - 12:45 PM ET
Location: Poster Board D-55

    Presenting Author(s)

  • SS

    Srishti Sankrityayan, n/a

    Student
    JSS Academy of Higher Education and Research, JSS Medical College and Hospital, Department of Paediatrics
    Mysuru, Karnataka, India

    • Co-Author(s)

  • MB

    Manvi Chowdary Bellam

    JSS Academy of Higher Education and Research, JSS Medical College and Hospital, Department of Paediatrics, India

  • PH

    Prajwala H. V.

    JSS Academy of Higher Education and Research, JSS Medical College and Hospital, Department of Paediatrics, India

  • CK

    Chethak K. B.

    JSS Academy of Higher Education and Research, JSS Medical College and Hospital, Department of Paediatrics, India

  • SJ

    Stuti Jajodia (she/her/hers)

    Student
    JSS Academy of Higher Education and Research, JSS Medical College and Hospital, Department of Paediatrics
    Mysuru, Karnataka, India

Disclosure(s):
Stuti Jajodia: No relevant financial relationship(s) with ineligible companies to disclose.


Objectives: Varicella (chickenpox), caused by the varicella-zoster virus (VZV), is usually mild in healthy children. In neonates, it is rare due to passive maternal immunity. When acquired perinatally, neonatal varicella can lead to severe complications, including pneumonia, septic shock, and disseminated infection, with mortality rates approaching 30%. Early diagnosis and intervention are vital for improving outcomes.

Methods: A 25-day-old neonate with failure to thrive (FTT) developed varicella after the mother developed skin lesions postpartum. The infant presented with respiratory distress and septic shock, requiring mechanical ventilation. Laboratory tests showed leucopenia and thrombocytopenia. The neonate received intravenous immunoglobulin (IVIg) and acyclovir. Chest X-ray revealed bilateral lung opacities suggestive of varicella pneumonia. Elevated procalcitonin levels indicated bacterial co-infection, prompting broad-spectrum antibiotics (ceftriaxone, linezolid, gentamicin). The infant was extubated within four days and discharged on day 10.

Results: Neonates whose mothers develop varicella around delivery are at higher risk for severe outcomes due to insufficient passive immunity. This case underscores the importance of early identification in neonates with risk factors like FTT. Rapid administration of antivirals, immunoglobulin, and antibiotics is crucial for improving survival and preventing complications in critically ill infants.

Conclusions: This case highlights the need for prompt treatment in neonates with varicella, especially those with pre-existing vulnerabilities. Early initiation of antiviral and antibiotic therapy, along with immunoglobulin, can significantly improve clinical outcomes and reduce the risk of long-term complications.

Funding Sources: None