The Patient with Chickenpox

Abstract

A 20-year-old, 60-kg Asian man was brought to the emergency room with a complaint of abdominal pain. He stated that he had been in good health until 5 days previously, when he developed fever and muscle pain. The following day he noticed multiple fluid-filled lesions distributed mostly on his trunk. He was treated at home with fluids, bed rest, and acetaminophen. Two days prior to hospitalization he developed a cough, followed by abdominal pain.

Physical exam revealed a fever of 102°F. Blood pressure was 130/60 mmHg, with a pulse of 84/min. Skin examination showed erythematous papules and vesicles in singlets and in clusters in a truncal distribution. Some lesions were beginning to crust. Auscultation of the chest was significant for fine crackles throughout the lung fields. Cardiac examination was unremarkable. Abdominal examination revealed absent bowel sounds, with rebound tenderness and guarding at McBurney’s point.

Laboratory data included a white cell count of 13,000 and a BUN and creatinine of 24 and 2.0, respectively; SGOT, 140; ECG, occasional premature ventricular complexes; chest x-ray, an interstitial infiltrate in both lung fields. Blood gas analyses revealed a pH of 7.45; PCO₂, 35: PO₂, 87. All other laboratory values were within normal limits.

The patient was scheduled for emergency appendectomy.