IS case 481: Varicella-zoster pneumonia

Durga Singh, MD

University of Rochester

Imaging Sciences URMC 2010
Publication Date: 2010-08-30


Patient is a 36-year-old male who immigrated from southwest Asia three months ago, and now has a pustular pruritic rash on his face and chest, chills, myalgias, sore throat, and night sweats.


Ill-defined nodular opacities measuring about 5-10 mm, absence of hilar lymphadenopathy, and absence of pleural effusion.


Varicella-zoster pneumonia


Varicella-zoster pneumonia is caused by the varicella-zoster virus, which is usually benign and self-limited with solely skin involvement in children. In neonates, there is 25% mortality for those born to mothers afflicted with varicella within 4 days of delivery or 2 days post-delivery. In adults, especially those who are immunocompromised, it can cause pneumonia. The reported prevalence of associated pneumonia with varicella infection in adulthood ranges from 5-50%. A rash occupying a dermatome is associated with this pneumonia, typically. Classic features of this include initial diffuse alveolar damage. With progressive disease, the nodules enlarge and become confluent, becoming infiltrative in appearance. and in recovery, spherical nodules that are scattered throughout the lung parenchyma. These nodules are 5-10 mm and are ill-defined in contour. There usually is no hilar lymphadenopathy or pleural effusion. They may persist up to several weeks and potentially may become calcified and better defined.


  1. Feldman S. Varicella-zoster virus pneumonitis. Chest. 1994 Jul;106(1 Suppl):22S-27S. PMID: 8020329
  2. Kim EA, Lee KS, Primack SL, et al. Viral pneumonias in adults: radiologic and pathologic findings. Radiographics. 2002 Oct;22 Spec No:S137-49. PMID: 12376607

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