Back issues No.4 - 2007 / Correspondence  

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Systemic Intravenous Corticosteroid Treatment of Adult Varicella Pneumonia
Chen-Hsi Hung , Tsu-Man Chiu
Dermatol Sinica 25: 287-288, 2007

This 35-year-old man was in good health until 6 days prior to admission, when he experienced malaise, high-grade fever, and symptoms of upper respiratory infection. He developed skin rashes 6 days before admission after contacted with his own child with chickenpox. On arrival, a chest x-ray showed fluffy opacities over both lungs(Fig. 1). He was admitted to our dermatological ward under the impression of varicella pneumonia. After admission, he received acyclovir and Ampicillin/Sulbactam (Unasyn(r)) administration. Two days later, persistent fever up to 38.6℃, and tachypnea with a respiratory rate of 50 breaths per minute were noted. A bilevel positive airway pressure (BiPAP) ventilator was given. Chest x-ray followed up revealed nodular fluffy opacities over both lungs(Fig. 2). Then he received intravenous Hydrocortisone (Solu-cortef(r)) 200 mg every 6 hours. The patient’s pulmonary gas exchange had substantial improvement. Five hours later, he was successfully weaned from the ventilator. He received intravenous Hydrocortisone (Solu-cortef(r)) 200 mg every 6 hours and acyclovir for a course of 2 and 7 days respectively. A chest x-ray followed up 2 days after administration of parental Hydrocortisone (Solu-cortef(r)) revealed some resolution of fluffy opacities (Fig. 3).

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