Case report: Chickenpox?

With most of the population apprehensive about rashes of any sort at our walk-in clinic, I see a multitude of patients (many children) with recent skin lesions. With limited experience, many patients (or their parents) believe that any rash is probably chickenpox.I just saw a baby girl—11 months old—who had developed a spectacular rash over the prior two days. Her five-year-old brother had developed the identical rash a couple of days previously—but the rash had spontaneously cleared with no treatment, before a physician could be consulted. The girl was fair-skinned, taking no medications, with no known allergies. She was afebrile and not ill—just itchy—and had been given Tylenol (the common cure-all for any medical condition). Read: Case report: Why me?Interestingly, despite her extreme youth, the patient had experienced rashes previously (as had her brother) which had been labelled “eczema” (the fall-back diagnosis for unknown rashes—when not suggestive of “chickenpox”). The current rash was very widespread, symmetrical; covering the whole body. The attached picture shows typical lesions on one leg. The patient was not thrilled with staying still for photography—hence the obvious light restraints. Afebrile, itchy, well-hydrated and behaving normally, the baby seemed unlikely to be suffering from systemic disease—although (for once), the rash certainly looked like chickenpox. The rash had probably arisen with contact with her brother. Although the baby was not yet vaccinated against chickenpox (varicella), her brother had been.With a history of eczema, contact with someone immunized (whose similar rash was transient), asymptomatic and not ill, I questioned whether the baby’s rash might not be chickenpox—despite appearance. Other papulopustular conditions are, in my experience, almost always associated with some constitutional complaints. I suggested usual care for the patient—avoiding (unlikely) use of aspirin or other NSAIDS—and tracking the progress of the rash. Bloodwork would ultimately show if the rash had truly been varicella—but I am not a fan of drawing blood from babies unless absolutely necessary. I wold be interested in the opinion of other physicians about the rash—and whether blood work should be done. The patient will be “isolated” until the rash resolves.Dr. Robert Dickson is a family physician in Hamilton. This report is based on a real case from Dr. Dickson’s files.

Case report: Chickenpox?

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