Varicella pneumonia. A report of 20 cases, with postmortem examination in six.

Twenty cases of primary varicella pneumonia, 16 in adults and four in children, were studied. Two adults and four children died, two of the latter with complicating bacterial infections. In two patients the primary cause of death was severe alveolar-capillary block. Staphylococcal septicemia, midbrain hemorrhage and meningoencephalitis were primarily responsible for death in other patients.Radiologically, the lungs showed diffuse, poorly marginated, nodular lesions, often peribronchial in location, more easily defined in the thinner peripheral lung fields, with an alveolar acinar pattern, tending to coalesce in the hilar and perihilar regions. Pathologically, the cutaneous varicella lesions were matched by similar lesions regularly found in the lungs and pleura, as well as the peritoneum and the liver. The pulmonary nodular lesions corresponded to alveoli, filled with precipitated protein and active inflammatory cellular material, surrounding the bronchioles, which themselves were often involved, and these in turn were surrounded by areas of normally aerated alveoli. Eleven moderately to severely ill patients were treated with antibiotics, six moderately to extremely ill were treated with antibiotics and adrenal cortical steroids. There was no evidence of significant change in the course of the disease resulting from use of steroid therapy.