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Department of Teaching, China Medical University Hospital, Taichung, TaiwanDepartment of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan
Corresponding author at: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, No. 2, Yude Road, Taichung 404, Taiwan. Tel.: +886 4 22052121x3485.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, TaiwanGraduate Institute of Clinical Medicine Science, College of Medicine, China Medical University, Taichung, Taiwan
Varicella pneumonia is the most serious complication, which commonly affects adults.
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Pulmonary nodules are the result of dystrophic calcification in the injured lung.
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Other etiology includes disseminated histoplasmosis and miliary tuberculosis.
1. Indication
A 78-year-old female with stroke and hydrocephalus post-ventriculo-peritoneal shunt insertion presented with shortness of breath, productive cough, and fever that had been present for several days. Physical examination revealed basal crackle and rale over the left low lung (LLL) field. Chest radiograph (Fig. 1) showed an alveolar pattern involving LLL and a left-side pleural effusion. In addition, we observed multiple calcified nodules over the whole lung field. No specific occupational exposure was recalled.
Fig. 1Chest radiograph showed an alveolar pattern over LLL, left-side pleural effusion, and multiple calcified nodules over the whole lung field.
A diagnosis of LLL pneumonia and parapneumonic effusion was made. The patient recovered well after empiric antibiotic treatment. A review of her history revealed that she had chicken pox when she was in her fifth decade. Therefore, the multiple calcified pulmonary nodules found on examination are a typical feature of a late sequel of varicella pneumonia.
Chickenpox is a highly contagious disease caused by the varicella-zoster virus. Although rare, varicella pneumonia is the most serious complication of chickenpox, which commonly affects adults. Patients may show impaired gaseous exchange, with progressive hypoxemia, and are at a high risk of respiratory failure [
]. Resolution of pneumonitis often parallels improvement of skin rash. Mortality rates seem to be improving with 6% in more recent data. However, in subsequent years, survivors show higher restrictive ventilatory or diffusion defects in addition to diffused miliary calcifications [
With regard to small calcified lung nodules, they are because of dystrophic calcification in the injured areas of the lung. Dystrophic calcification is followed by caseation, necrosis or fibrosis. Varicella pneumonia may cause widespread minute micronodular calcifications (nodule diameter, 1–3 mm) as a late sequela. However, no associated calcifications are observed in the mediastinal lymph nodes. Major differential diagnoses include disseminated histoplasmosis and miliary tuberculosis [
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