International Journal of Science and Research (IJSR) ISSN: 2319-7064 SJIF (2020): 7.803 Volume 11 Issue 1, January 2022 www.ijsr.net Licensed Under Creative Commons Attribution CC BY A Rare Case of Congenital Varicella in 14 Days-Old Girl Baby Octi Setyarini 1 , I Wayan Gustawan 2 , I Made Gede Dwi Lingga Utama 3 1-4 Department of Child Health, Medical Faculty of Udayana University/Sanglah Hospital, Denpasar, Indonesia Abstract: Varicella is a rare disease in infant. Maternal varicella between day 5 antepartum to day 2 postpartum may develop congenital varicella with fatal illness. We reported a 14-days-old girl baby presented with chief complaint widespread pleomorphic rash and fever. Patients complained rash on whole body since 3 days before admitted to hospital. The rash initially appeared on chest then spread to face, both of her hands and feet. Redness spots filled with fluid, ruptured, then dry and form crust. There was history of fever since 4 days before admitted to hospital, with the highest temperature 39 0 C. The patient had laziness to drink. Her mother had fever 2 hours after delivery and varicella rashes 6 hours after delivery. During physical examination, the patient’s body temperature was 38.5°C. Laboratories examination revealed reactive anti-varicella zoster IgM. The mother’s antibody revealed reactive anti-varicella zoster IgG. The patient was administered intravenous acyclovir for 7 days. We don’t have varicella-zoster immune globulin (VariZIG) in our hospital. The lesions recovered on day 9 of treatment and she was discharged. Varicella in the neonates is associated with high morbidity and mortality, but treatment with acyclovir combined with supportive therapy has resulted good outcome. Keywords: varicella, congenital, acyclovir 1.Introduction Varicella-zoster virus (VZV) is a highly contagious infectious agent that causes primary varicella infection, known as varicella. Its main target is T lymphocytes, epithelial cells and ganglia [1]-[3]. Varicella can affect all age groups with the highest proportion were children less than 10 years of age. The incidence peaks at 5-9 years of age. The incidence of congenital varicella in Indonesia is not certain, but the overall incidence of maternal and congenital varicella has decreased over the past 10-15 years, presumably due to varicella vaccination [1]. There are three forms of varicella-zoster infections involving in fetus and neonate: fetal, congenital (early neonatal) and postnatal [1]-[2]. Congenital (early neonatal) varicella infection occurs when pregnant woman suffers varicella during the last 3 weeks of pregnancy or within the first few days postpartum. Disease begins just before delivery or within the first 10-12 days of life [2], [4]. The clinical manifestation include widespread, intensely pruritic vesicular rashes. Affected individuals typically have 250-500 lesions with varying stages of evolution, often associated with fever or other systemic symptoms. Although the most common complication of varicella is bacterial superinfection from skin lesions, varicella pneumonia is the most common cause of mortality. Other complications of varicella infection include acute cerebellar ataxia, encephalitis, thrombocytopenia, and Reye Syndrome [2]. Varicella-zoster immune globulin (VariZig) should be adminitered as soon as possible, ideally within 72-96 hours after exposure, although administration may be useful up to 10 days postexposure. Intravenous immune globulin (IVIG) may also be considered if VariZig is unavailable. Antiviral therapy with acyclovir may also be indicated [1], [3], [5]. 2.Case Report A 14 days-old girl baby with chief complaint widespread pleomorphic rash on the whole body since 3 days before admitted to the hospital. The rash initially appears on chest then spread to face, back and both of hands and feet. Redness spots filled with fluid and rupture. There was history of fever since 4 days before admitted to the hospital, with the highest temperature 39 0 C. The baby developed laziness to drink since 1 day before admitted to the hospital. Patient was born spontaneously from mother with varicella. Mother had fever 2 hours after delivery and also had redness spots on stomach since 6 hours after delivery and the next day spread to the whole body. Mother received acyclovir therapy so that the mother prohibited from giving breast milk during taking medication. On the first day of hospitalization, patient still suffered fever and lazy to drink, with the body temperature was measured 38.5°C. Other vital signs were within normal limit. From physical examination, there was multiple vesicles with erythema skin, rounded, scattered throughout body, diameter 0.1-0.3 cm, partially ruptured to form erosion covered brownish black crust. Complete blood count revealed white blood cell 12.9x10 3 /uL (neutrophils 5.5x10 3 /uL (42.63%)); haemoglobin 15.27 g/dL; haematocrit 46.09%; platelets 150.2x10 3 /uL. Patient was assessed with congenital varicella and treated in isolation room. Patient was given formula milk and parenteral nutrition. Patient was planned to get VariVIG/IVIG but no VariVIG/IVIG in our hospital. Patient got acyclovir 15 mg/kg/dose every 8 hours (intravenous), planned for 7 days. Paper ID: SR22108003702 DOI: 10.21275/SR22108003702 687