An Unusual Case of Severe Varicella Zoster Infection Complicated by Acute Renal Failure in an 8-year-old Nigerian Boy

Abstract

Background: Varicella zoster virus (VZV) infection is highly contagious and has a worldwide distribution. It is predominantly a childhood disease and frequently runs a benign course. However, serious complications such as target organ damage could occur in older immunocompetent children. Acute kidney injury (AKI) arising from varicella infection is one of the rare complications in children.

Case Report: The patient presented with body rash typical of varicella, fever, cough, difficulty in breathing, vomiting and dark urine. He had contact with his two siblings with similar rashes. He was febrile, centrally cyanosed with generalised lymphadenopathy and body rashes at different stages of development. He had tachypnoea, dyspnoea and widespread coarse crepitations. Kidneys were enlarged and urinalysis revealed microscopic haematuria of 4+ and proteinuria 1+. Initial assessment of chickenpox with pneumonia and nephritis was made. He received oral acyclovir among other interventions. His estimated glomerular filtration rate dropped from 120 to 8.71mls/min/1.73m². He had 3 sessions of haemodialysis, his biochemical parameters normalised and has been on follow-up for one year with normal renal function.

Conclusion: Acute varicella infection can lead to clinically significant kidney failure in otherwise healthy children. Prompt renal replacement therapy could result in complete recovery of kidney function.