A 5-year-old presents with fever and a distinct rash: small oval vesicles on different stages of evolution (macules, papules, vesicles, pustules, scabs simultaneously on the same area of skin), appearing first on the trunk. The MOST serious potential complication of the causative virus in an immunocompromised child is:
- A Varicella encephalitis and disseminated VZV with hepatitis ✓
- B Post-herpetic neuralgia
- C Reye syndrome from aspirin use
- D Secondary bacterial superinfection — impetigo
Explanation
The described rash with polymorphous lesions in multiple stages simultaneously (centripetal distribution, trunk first) is classic for varicella (chickenpox) caused by VZV. In immunocompromised children (malignancy, HIV, immunosuppressants), VZV can cause disseminated disease: varicella pneumonitis, encephalitis, hepatitis, and DIC — with mortality up to 30% without treatment. Early IV acyclovir is mandatory in immunocompromised individuals. Post-herpetic neuralgia is a complication of herpes zoster (reactivation), not primary varicella, and is rare in children. Reye syndrome is a complication of aspirin use during viral illnesses, not the virus itself. Secondary bacterial superinfection is common but not the most serious complication.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.