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Varicella zoster pneumonia

Reviewer: Elliot Weisenberg, M.D. (see Reviewers page)
Revised: 6 September 2011, last major update September 2011
Copyright: (c) 2003-2011, PathologyOutlines.com, Inc.

Clinical features

● Overwhelmingly a benign disease in childhood (Eur J Clin Microbiol Infect Dis 2011;30:435)
● Adults with infection have 25x risk of children in developing pneumonia; occurs in 10-15% of adult patients (Ann Thorac Med 2007;2:163)
● Greatest risk of severe disease in immunosuppressed patients, especially bone marrow transplant recipients, patients with chronic lung disease, preganant women and neonates
● Incidence has declined with effective treatment, but is increasing due to unvaccinated individuals
● Diagnosis usually apparent from skin lesions and clinical history, but immunohistochemistry, culture or PCR may be necessary to rule out HSV
● Pneumonia usually occurs 2-7 days after rash appears
● Pulmonary calcifications may occur after recovery
● Untreated pneumonia has 10-40% mortality rate

Gross description

● Heavy, firm and purple lungs
● May have hemorrhagic lesions on pleura resembling skin lesions

Micro description

● Necrosis of bronchial and alveolar epithelium, acute inflammation and hemorrhage, eosinophilic nuclear inclusions and rare multinucleated cells at edge of necrotic foci

Micro images

Various images

End of Lung-nontumor > Infections > Varicella zoster pneumonia

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