After several days of suffering fever, headache, and malaise, a 17-year-old boy noticed a rash developing over much of his body. He sought medical attention and was admitted to the hospital.

The rash consisted of diffuse, irregularly scattered red bumps and small blisters (A and B). The patient reported no personal history of chickenpox and denied recent exposure to the disease. Chickenpox, caused by the varicella-zoster virus, became the working diagnosis.

A few hours after the initial examination, the patient complained of severe respiratory distress; assisted ventilation was initiated. Pulmonary edema was noted on the chest film (C). Bone marrow failure and hepatitis developed as well. Biopsy specimens were obtained from lesions on the chest (D), and culture confirmed the diagnosis of chickenpox. Blood cultures were negative and bacterial sepsis was not suspected.

These uncommon but serious complications of chickenpox may be attributed to hematogenous viremia that has been shown to disseminate to virtually every organ.

Therapy included a 10-day course of intravenous acyclovir, intravenous corticosteroids, and supportive care. The serious multiorgan dysfunction improved, and the patient was released from the hospital after 2 weeks of treatment.