Varicella Pneumonia in Otherwise Healthy 31-Year-Old Female Nonsmoker With No Prior Varicella Immunity

Varicella pneumonia is a relatively rare but severe complication of primary varicella infection. It primarily affects adults and is exacerbated by risk factors such as smoking, immunocompromised status, and male gender. Left untreated, the mortality associated with varicella pneumonia is high and ranges from 10-30 percent in the literature. This is a case of an adult female patient with no prior immunity to varicella who presented with increased oxygen requirements approximately 5 days after the onset of cutaneous symptoms. Her symptoms quickly improved after 1-day post administration of valacyclovir, and on discharge, she was prescribed a 7-day course of valacyclovir. Early treatment with acyclovir is the mainstay of treatment and is essential as it has been shown to reduce long-term complications and decrease mortality. Despite the low incidence of varicella pneumonia among patients with primary varicella infection, the index of suspicion for varicella pneumonia among patients with primary varicella infection should be high in the setting of increased oxygen requirements due to the mortality and symptomatic benefits of early treatment.

A Rare Case of Skin Necrosis Following Extravasation of Prothrombin Complex Concentrate (PCC) Infusion During Warfarin Reversal

Warfarin-induced skin necrosis is a well-documented complication that can occur following commencement of warfarin. However, skin necrosis following extravasation of prothrombin complex concentrate (PCC) infusion is a very rare adverse event that is not commonly documented. This case illustrates the possibility of developing skin necrosis following the administration of an anticoagulation reversal agent rather than from anticoagulation itself. We report a case of a 58-year-old male who developed skin necrosis at the site of PCC infusion in the right upper extremity (RUE) for warfarin reversal of an elevated international normalized ratio (INR). The skin necrosis progressed into a full thickness chemical burn. As a result, the patient underwent allograft followed by split thickness autograft and RECELL placement. This case presentation describes the first reported case of skin necrosis following extravasation of PCC infusion during warfarin reversal.

Herpes Simplex Virus Causing Necrotizing Granulomatous Lymphadenitis

Localized necrotizing granulomatous lymphadenitis (GLA) is a very rare presentation of herpes simplex virus (HSV) infection. We are reporting a case that required multidisciplinary expertise to confirm the diagnosis and effectively treat the patient. Our patient had a recent diagnosis of chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) and presented with hematuria and palpable inguinal lymph nodes. Affirmative diagnosis required a core biopsy of the lymph node with immunochemistry staining and polymerase chain reaction (PCR) testing. This case reviews the unusual presentation of an HSV infection and emphasizes the importance of maintaining a high index of suspicion for infection when treating an immunocompromised patient with persistent symptoms.