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Neonatal varicella: a rare case

  • Nanda Earlia ,
  • Wahyu Lestari ,
  • Fitri Dewi Ismida ,
  • Annisa Amalia ,
  • Aqil Yuliawan Tasrif ,
  • Mikyal Bulqiah ,
  • Dea Silvia Ramadana ,


Introduction: Varicella-zoster virus (VZV) infection in pregnant women in the last three weeks of pregnancy or the days before delivery causes neonatal varicella. It is rare in newborns and infants due to passive immunity received from the mother. Thus we report a rare case of neonatal varicella for an educational purpose.

Case report: A 14-day-old girl was referred to the Department of Pediatrics with a red rash all over her body. The red rash begins on the face and subsequently spreads across the body fever for four days before the appearance of the rash. During the third trimester of pregnancy, the patient's mother had varicella. The patient was delivered vaginally by the midwife at full term, weighing 3,400 g. Macules, papules, pustules, and vesicles, multiple in number, distinct, miliary to guttate in size, and universal distribution, were identified on physical examination in the facial, thoracic, and upper extremities region et inferior bilaterally. The Tzank test found multinucleated giant cells. Skin biopsy found stratum spinosum edema with powdered lymphocyte inflammatory cells (typical for varicella). Treatment with intravenous acyclovir showed improvement after 5 days.

Conclusion: VZV generates a wide spectrum of clinical symptoms in the fetus and newborn and can be a life-threatening condition. Early recognition of pregnant women and newborns who are at risk for VZV infection is very necessary so that prophylaxis and treatment can be started immediately


  1. Silverman RA, Boos MD. The Exanthematous Diseases of Childhood. In: Paller AS, Mancini AJ, editors. Hurwitz Clinical Pediatric Dermatology: A Textbook of Skin Disorders of Childhood and Adolescence. 5th ed. New York: Elsevier; 2012.
  2. Blumental S, Lepage P. Management of varicella in neonates and infants. BMJ Paediatrics Open. 2019;3(1):1–6.
  3. Kulhan M, Kulhan NG, Nayki UA, Nayki C, Ulug P. Case Report Varicella infections during pregnancy and literature review : A case report. 2017;4(1):11–4.
  4. Nurhayati RH. Manajemen Varisela Neonatal. Cermin Dunia Kedokteran [Internet]. 2020;46(11):672–4. Available from:
  5. Straus SE, Oxman MN, Schmader KE. Varicella and Herpes Zoster. In: Fitzpatrick’s Dermatology In General Medicine. 2nd ed. Philadelphia: Mc Graw Hill Education Medical; 2017. p. 1885.
  6. Kennedy PGE, Gershon AA. Clinical features of varicella-zoster virus infection. Viruses. 2018;10(11):1–11.
  7. Ahn KH, Park YJ, Hong SC, Lee EH, Lee JS, Oh MJ, et al. Congenital varicella syndrome: A systematic review. Journal of Obstetrics and Gynaecology. 2016;36(5):563–6.
  8. Neo AGE, Choi EH, Chokephaibulkit K, Choudhury J, Kuter B, Lee P-I, et al. Burden of varicella in the Asia-Pacific region: a systematic literature review. Expert Review of Vaccines [Internet]. 2019; Available from:
  9. Lai JW, Ford T, Cherian S, Campbell AJ, Blyth CC. Case Report: Neonatal Varicella Acquired From Maternal Zoster. Frontiers in Pediatrics. 2021;
  10. Trotta M, Borchi B, Niccolai A, Venturini E, Giaché S, Sterrantino G, et al. Epidemiology, management and outcome of varicella in pregnancy: a 20-year experience at the Tuscany Reference Centre for Infectious Diseases in Pregnancy. Infection [Internet]. 2018;46(5):693–9. Available from:
  11. Petersen R, Miller AS. Varicella zoster virus infection in neonates. NeoReviews. 2016;17(9):e507–14.
  12. Queirós C, Santos MC, Pimenta R, Filipe P. Transient Cutaneous Alterations of the Newborn. European Medical Journal. 2021;6(1):97–106.
  13. De Paschale M, Clerici P. Microbiology laboratory and the management of mother-child varicella-zoster virus infection. World Journal of Virology. 2016;5(3):97.
  14. Bergqvist C, Abi Aad Y, Nassar D, El Zein S, Kanj SS. Disseminated herpes simplex virus and varicella zoster virus co-infection in a patient with idiopathic thrombocytopenic purpura. Journal of Infection and Public Health [Internet]. 2019;12(3):438–41. Available from:
  15. Sauerbrei A. Diagnosis, antiviral therapy, and prophylaxis of varicella-zoster virus infections. European Journal of Clinical Microbiology and Infectious Diseases [Internet]. 2016;35(5):723–34. Available from:
  16. Vancea G, Calistru PI, Ceausu E. Varicella-zoster Virus Infection in Pregnancy. Romanian Journal of Infectious Diseases. 2018;21(3):96–104.
  17. Lachiewicz AM, Srinivas ML. Varicella-zoster virus post-exposure management and prophylaxis: A review. Preventive Medicine Reports [Internet]. 2019;16(November):101016. Available from:
  18. Singh M, Breuer J. Varicella zoster virus infections. In: Viral Infections of the Human Nervous System. 2013. p. 87–114.
  19. Cherukuri N, Lingaldinna S, Anjum S, Singh H. Congenital varicella syndrome in a neonate. Vol. 6, Indian Journal of Child Health. 2019. p. 142–3.
  20. Sauerbrei A, Wutzler P. Neonatal varicella. Journal of Perinatology. 2001;21(8):545–9.

How to Cite

Earlia, N., Lestari, W., Ismida, F. D., Amalia, A., Tasrif, A. Y., Bulqiah, M., & Ramadana, D. S. (2022). Neonatal varicella: a rare case. Bali Medical Journal, 11(1), 495–498.




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