BMJ Case Reports 2012; doi:10.1136/bcr.11.2011.5211

Background: Neonatal varicella infection is a rare condition with an incidence of 2-6 per 100,000 live births per year. Neonates born 2 days before or 4 days after the onset of maternal varicella can develop serious illness. Without treatment, the case fatality rate approaches 30%. The American Association of Pediatrics recommends administration of varicella zoster immunoglobulin (VZIG)  to  newborns who are born from mothers with a varicella infection 5 days before delivery and 2 days after delivery.
Case Presentation: A 17-year old female gave birth at 40 weeks by normal spontaneous vaginal delivery. She developed scattered vesicles on her trunk 1 day prior to delivery. The rash subsequently extended to her face and extremities. She did not receive any treatment. After delivery the mother was separated from the baby for 2 days. She gave a history of a concurrent varicella infection of her nephew who stayed in the same house as her 3 days before she gave birth.
Nine days after birth the neonate was taken to a rural clinic in northern Thailand with a rash and fever for 3 days. He was prescribed amoxicillin syrup, but subsequently deteriorated. Three days later he presented to the Chiang Mai University Hospital (CMUH) the physical examination was remarkable for a temperature of 39? C, irritability, cluster of small shallow ulcers on erythematous base on the hard palate, and generalized tense vesicles, with some areas of yellowish crusts, including the face, lips, genitalia, palms and soles. He was diagnosed neonatal varicella infection with secondary superimposed bacterial infection of the skin and pneumonia.The neonate was started on intravenous acyclovir (60 mg/kg/day) along with supportive therapies. The boy has completely recovered after treatment and was discharged home on day 14 with progressive resolution of rash.
Conclusions: Neonatal varicella infection is a rare condition since vaccine introduction. The authors report the case of a 12-day old male who presented with a fever and generalized vesicular eruption. The patient’s mother had varicella infection 1 day before delivery without treatment. The neonate initially did not receive prophylaxis or treatment. He subsequently was started on intravenous acyclovir and recovered without further complications or sequelae. Prompt diagnosis and treatment for maternal prenatal varicella infection is necessary to prevent infection in the newborn, and healthcare provider awareness to avoid nosocomial transmission.