Successful Treatment of a Rare Complication of Varicella Pneumonitis in an Immunocompromised 11-Year-Old Child Using Pooled Intravenous Immunoglobulin

Varicella-zoster virus, or herpes zoster virus, is a human alphaherpesvirus. It causes varicella (chicken pox) and herpes zoster (shingles). Though a relatively common and benign childhood illness, it can lead to severe disseminated infections in immunocompromised patients. Varicella pneumonitis is a common complication of varicella found in adults but is rare in children. As such, we present a rare case of an 11-year-old immunosuppressed male on methotrexate who developed a disseminated varicella infection resulting in pneumonia. Methotrexate is not known to cause immunosuppression, as compared to infliximab, which is similarly indicated for rheumatoid autoimmune conditions. He was treated with high-dose acyclovir and pooled intravenous immunoglobulin (IVIG). Due to the efficacy of high-dose acyclovir in immunocompromised patients with varicella-zoster and modern preparations of IVIG containing high titers of zoster immunoglobulins, the treatment allowed the patient to recover fully.