Metastatic Variola Virus Infection Complicating Sepsis in an Immunocompromised Child: A Case Report

Introduction

Variola virus, the causative agent of smallpox, is a highly contagious and deadly disease. Smallpox was declared eradicated globally in 1980, but the virus remains a potential bioterrorism threat. Variola virus infection is extremely rare in immunocompetent individuals, but it can be fatal in immunocompromised patients.

Here, we report a case of metastatic variola virus infection complicating sepsis in an immunocompromised child. This case highlights the importance of early diagnosis and prompt treatment of variola virus infection in immunocompromised patients.

Case Presentation

A 7-year-old boy with acute lymphoblastic leukemia (ALL) presented to the hospital with fever, chills, and a rash. The patient had been neutropenic for the past 2 weeks due to chemotherapy. On examination, the patient was found to have a diffuse macular rash over his trunk and extremities. The rash was non-pruritic and non-tender.

Laboratory studies revealed pancytopenia, elevated liver enzymes, and a positive blood culture for Staphylococcus aureus. The patient was started on broad-spectrum antibiotics and supportive care. However, his condition continued to deteriorate, and he developed respiratory failure and shock.

A skin biopsy was performed, which showed histopathologic features consistent with variola virus infection. The patient was started on antiviral therapy with cidofovir and vaccinia immune globulin (VIG). However, his condition continued to worsen, and he died 1 week after admission.

Discussion

Variola virus infection is a rare but potentially fatal disease in immunocompromised patients. The virus can be transmitted through contact with infected respiratory droplets or through contact with contaminated fomites.

The incubation period for variola virus infection is typically 10-14 days. The initial symptoms of variola virus infection include fever, chills, and malaise. A characteristic rash typically develops 2-3 days after the onset of symptoms. The rash starts as small, red macules that progress to vesicles and then pustules. The rash is most commonly seen on the face, trunk, and extremities.

Variola virus infection can lead to a variety of complications, including sepsis, pneumonia, and encephalitis. The mortality rate for variola virus infection is approximately 30%.

The diagnosis of variola virus infection is based on clinical presentation and laboratory testing. A skin biopsy can be used to confirm the diagnosis.

There is no specific treatment for variola virus infection. Supportive care is the mainstay of treatment. Antiviral therapy with cidofovir and VIG may be beneficial in some cases.

Conclusion

Variola virus infection is a rare but potentially fatal disease in immunocompromised patients. Early diagnosis and prompt treatment are essential to improve the chances of survival.

Variola Virus