A 7-year-old child presents with fever and a skin rash consisting of crops of lesions in different stages — macules, papules, vesicles, and crusted lesions — predominantly on the trunk. The lesions are intensely pruritic. The child received MMR vaccine but not varicella vaccine. Which complication is most feared in immunocompromised children with this infection?
- A Disseminated varicella with visceral involvement ✓
- B Post-infectious encephalomyelitis
- C Reye syndrome
- D Bacterial superinfection with Group A streptococcus
Correct answer: A. Disseminated varicella with visceral involvement
Explanation
This is varicella (chickenpox) caused by varicella-zoster virus. The characteristic finding is pleomorphic rash with lesions in different stages simultaneously (dewdrop on rose petal vesicles), predominantly centripetal distribution. In immunocompromised hosts (e.g., those on steroids, HIV-infected, or with leukemia), varicella can disseminate widely, causing pneumonitis, hepatitis, encephalitis, and DIC — disseminated varicella — which carries significant mortality. These children should receive IV acyclovir promptly.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.