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On physical examination, diffuse bilateral inspiratory and expiratory wheezes were noted. The patient had a temperature of 98 degrees and a pulse of 108 beats per minute.
On the CT study performed without intravenous contrast, ill-defined nodular opacities are visible without evidence of cavitation. Adjacent areas of ground glass opacification are notable. No lymphadenopathy or pleural effusion is present. Peripheral cystic spaces are consistent with paraseptal emphysema.
The varicella-zoster virus (VZV), which causes chicken pox and shingles, may cause life threatening pneumonia particularly in pregnant women and immune-compromised patients. VZV may invade the lungs and cause diffuse pneumonia, ranging in severity from mild respiratory symptoms to fulminant, life-threatening disease. In some reports, rales or other auscultatory findings were evident in only 50% of patients. Radiographic findings range from interstitial abnormality to diffuse airspace disease. VZV displays an affinity for epithelium and may invade any organ. The mainstay of treatment for VZV respiratory infection is acyclovir, which has been shown to lessen the duration and severity of symptoms in this disease.
Gogos CA, et al. Respiration 59(6): 339-43.
Conte PI, et al. Radiology 95(2):267-72.
Reese RE, Douglas RG, editors. A practical approach to infectious diseases. Boston: Little Brown and Co, 1986.