Introduction : Transplant patients are at risk of extensive cutaneous involvement and visceral dissemination, which may lead to pneumonia, hepatitis, encephalitis, and disseminated intravascular coagulopathy. These complications cause a great deal of morbidity and are associated with a high mortality rate. Varicella is rare in adult solid organ transplant recipients, as the majority is already seropositive. We report on a liver transplant recipient with no prior history of VZV infection.

Methods : A 48-year-old male underwent an orthotopic liver transplant for Hepatitis B virus liver cirrhosis in July 2017. Both inguinal herniorraphy was performed at 2 months later after transplantation. Three weeks later after herniorrpahy, the patient visited the emergency room with back pain. At that time, the patient was diagnosed with varicellar infection due to the presence of whole body blisters.

Results : The patient received IV acyclovir and showed improvement of skin lesion. In addition, he needed IV ganciclovir for CMV co-infection. However, during IV ganciclovir treatment, dyspnea and high fever was onset, and chest CT revealed pneumonia. Even though antibiotic treatment and addition of antifungal agent, pneumonia did not improve for one week. The followed up chest CT revealed atypical pneumonia with pleural effusion, atypical pneumonia were thought to be caused by varicellar involvement and TB was detected on pleural effusion. He received additional IV acyclovir and TB medication, and had recovered and discharged at post admission 60 days.

Conclusions : Cautious monitoring and early intervention are needed for Varicellar-type infection .