Education And Debate

Lesson of the Week: Near fatal chickenpox during prednisolone treatment

BMJ 1994; 309 doi: (Published 22 October 1994) Cite this as: BMJ 1994;309:1069
  1. P Rice,
  2. K Simmons,
  3. R Carr,
  4. J Banatvala
  1. Departments of Virology and Haematology, United Medical and Dental Schools of Guy's and St Thomas's Hospitals, St Thomas's Campus, London SE1 7EH
  1. Correspondence to: Professor Banatvala
  • Accepted 11 April 1994

The incidence of chickenpox (varicella) is increasing; thus, the proportion of cases in England and Wales in those over 14 years of age has increased from 10% to 25% between 1970 and 1990.1 Although usually mild among children, varicella is often severe and occasionally life threatening in adults, particularly in those whose immune systems have been suppressed by disease or treatment with corticosteroids.2,3 Corticosteroids are widely prescribed: over 5.5 million prescriptions for systemic corticosteroids were issued by general practitioners in the United Kingdom for the year ending September 1993 (Intercontinental Medical Statistics, personal communication). We describe a case of severe chickenpox in a patient being treated with high dose corticosteroids and put forward recommendations to reduce the risk of further cases.

Patients taking corticosteroids who are susceptible to chickenpox must receive immediate prophylaxis on contact with varicella; the steroid card should be amended

Case report

We admitted a 27 year old woman with a 36 hour history of severe lower back pain. She had been taking steroids for six weeks; she started taking prednisolone 60 mg daily for idiopathic thrombocytopenia, but for the two weeks before admission she had been taking 30 mg daily. Twenty four hours after admission she developed a fever of 37.8°C and a maculopapular eruption with vesicles over the neck and shoulders. Vesicular fluid contained herpes virus particles, and we confirmed varicella zoster virus by immunofluorescence. The patient had not had chickenpox before, but she had been in contact with fellow students from her college, where there had been a number of recent cases.

We started treatment with …

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