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LETTER TO EDITOR
Year : 2018  |  Volume : 19  |  Issue : 2  |  Page : 176-177

Varicella masquerading as pemphigus vulgaris


Department of Dermatology, Venereology and Leprology, RNT Medical College, Udaipur, Rajasthan, India

Date of Web Publication26-Mar-2018

Correspondence Address:
Lalit Kumar Gupta
Department of Dermatology, Venereology and Leprology, RNT Medical College, Udaipur - 313 001, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpd.IJPD_77_17

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How to cite this article:
Beniwal R, Gupta LK, Khare AK, Mittal A, Mehta S, Balai M. Varicella masquerading as pemphigus vulgaris. Indian J Paediatr Dermatol 2018;19:176-7

How to cite this URL:
Beniwal R, Gupta LK, Khare AK, Mittal A, Mehta S, Balai M. Varicella masquerading as pemphigus vulgaris. Indian J Paediatr Dermatol [serial online] 2018 [cited 2019 Dec 13];19:176-7. Available from: http://www.ijpd.in/text.asp?2018/19/2/176/217485



Sir,

A 14-year-old male presented with a 5-day history of low-grade fever, oral ulcers, and multiple, itchy fluid-filled lesions all over his body. The patient had received oral prednisolone 40 mg daily with the presumptive diagnosis of pemphigus vulgaris before reporting to us. The lesions aggravated following the treatment. Examination showed multiple, flaccid vesiculobullous lesions and erosions of varying size and shape over trunk and limbs. A few umbilicated vesicles were also noted [Figure 1]a and [Figure 1]b. Oral examination revealed multiple, 2–3 mm discrete, erythematous, punched out necrotic ulcers over palate. Tzanck smear from skin demonstrated multinucleate giant cells and a few acantholytic cells [Figure 2]a and [Figure 2]b. Gram stain and bacterial culture did not show organisms. The patient was treated with aciclovir 800 mg 5 times a day for 7 days. The lesions healed with hyperpigmentation in 2 weeks [Figure 3]a and [Figure 3]b.
Figure 1: (a and b) Vesiculobullous lesions of varicella with a few umbilicated vesicles on trunk

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Figure 2: (a and b) Tzanck smear showing acantholytic cells and multinucleated giant cells (Giemsa stain, ×40)

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Figure 3: (a and b) Lesions on trunk showing hyperpigmentation after treatment

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Varicella is the most common viral infection among children.[1] Bullous chickenpox, also known as varicella bullosa, is a rarely reported variant of chickenpox that can affect both children and adults. Varicella bullosa resembles ordinary varicella but is complicated by the formation of giant bullae.[2] The pathogenesis of bullous lesion formation is not completely understood. The bullae may represent coalescence of multiple vesicles or result from superimposed bullous impetigo/staphylococcal scalded skin syndrome.[3] Modern techniques including polymerase chain reaction have strongly supported varicella zoster virus involvement in the development of bullae.[4] Bullous lesions are not related to the severity of the disease nor the prognosis, nor produce unusual residuals. The bullous lesions do not seem to alter the course or prognosis of chickenpox.[5] This condition may clinically mimic bullous erythema multiforme, bullous arthropod bite reaction, bullous impetigo and/or autoimmune bullous, and mechanobullous diseases.[3] Kaposi's varicelliform eruption or eczema herpeticum is another differential diagnosis characterized by clusters of umbilicated vesicopustules, occurring in those with preexisting skin conditions, mostly atopic dermatitis.[6]

Clinicians should be aware of this rare presentation of varicella to avoid misdiagnosis. This was seen in our case too who was initially diagnosed and treated as pemphigus vulgaris. The presence of fever and umbilicated vesicles may provide important clinical clues to the diagnosis of bullous varicella.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient's parents have given consent for images and other clinical information to be reported in the journal. The patient's parents understand that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Sathyanarayana BD. Varicella bullosa. Indian J Dermatol Venereol Leprol 2003;69:56-7.  Back to cited text no. 1
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2.
Yoshida M, Kusuda S, Tezuka T. Varicella bullosa in an adult. Br J Dermatol 1990;123:846-8.  Back to cited text no. 2
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3.
Kurban M, Saleh Z, El Shareef M, Kibbi AG, Ghosn S. Bullous chickenpox: An unusual clinical variant of varicella. Int J Dermatol 2008;47:933-5.  Back to cited text no. 3
[PUBMED]    
4.
Sulik A, Szkoda MT, Oldak E. Bullous varicella in a 5-month-old infant. Clin Exp Dermatol 2008;33:102-3.  Back to cited text no. 4
[PUBMED]    
5.
Canby, J.P. Blakely L. Bullous chickenpox (varicella bullosa). Clinical Pediatrics 1963;2:13-5.  Back to cited text no. 5
    
6.
Olson J, Robles DT, Kirby P, Colven R. Kaposi varicelliform eruption (eczema herpeticum). Dermatol Online J 2008;14:18.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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