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Abstract: A middle-aged female presented to the clinic with a self-reported fever with peripheral discomfort and sore throat without any cause 3 days ago. 2 days ago, she developed a rash and herpes with pruritus, and a complete routine blood test showed a decreased white blood cell count and low absolute lymphocyte value, and an antibody test for varicella-zoster virus showed positive, thus confirming the diagnosis of viral fever due to varicella. After 8 days of antiviral, immunomodulatory and symptomatic treatment, the body temperature returned to normal, and the rash crusted off and was discharged from the hospital.
Basic information】Female, 37 years old
Disease Type】Chickenpox, viral fever
Hospital】Liaoning Provincial People’s Hospital
Date of consultation】April 2019
Treatment plan】Medication (ganciclovir injection, thin glucose peptide injection, glyburide lotion, mupirocin ointment)
【Treatment period】Inpatient treatment for 8 days, outpatient follow-up after 1 week
Treatment effect】The body temperature returned to normal, the rash crusted off, and was discharged from the hospital.
I. Initial consultation
The patient is a 37-year-old female, self-reported: 3 days ago, she developed a fever with a maximum temperature of 38.0℃, accompanied by discomfort and sore throat. 2 days ago, she developed a rash, starting with a small amount of herpes on the forehead, followed by a blistering rash on the face, scalp and extremities, with obvious itching.
On examination, the body temperature was 36.3℃, and a large number of papules and blistering rashes were seen on the scalp, face, trunk and limbs, some of which were broken, and a preliminary diagnosis of viral fever due to chickenpox was made based on the characteristics of the rash. The routine blood test showed that the white blood cell count was reduced and the absolute value of lymphocytes was low, which was consistent with the characteristics of viral fever, and the antibody test for varicella-zoster virus was positive.
II. Treatment
Chickenpox is contagious, so the patient was recommended to be hospitalized for isolation treatment, and the patient agreed to be admitted for isolation treatment because he had children at home. After the examination, the patient was confirmed to have viral fever caused by chickenpox and given standard antiviral and immunomodulatory treatment. In addition, the immunity of the body can be improved with the use of thin glucose peptide injection. For itchy skin, give topical application of Furfuryl Glycolate lotion. If the rash breaks down, apply mupirocin ointment to fight infection. During the treatment period, it is advisable to have a light diet, avoid spicy stimulation, take more rest and drink more water.
III. Treatment effect
After 8 days of isolation treatment and careful care, the patient’s body temperature returned to normal, the sore throat improved, the herpes did not increase and began to gradually crust. After 8 days of hospitalization, all the herpes on the body were crusted over and some of the herpes scabs fell off, leaving no scar, so the patient was no longer infectious and could be released from isolation. It is recommended that the patient return to the hospital in 1 week for a follow-up check to clarify the recovery situation.
IV. Notes
The patient was discharged from the hospital after 8 days of treatment and was very happy as the attending physician. Chickenpox infection is generally immune for life and will not re-infect the chickenpox, but some of the virus can be latent in the ganglia of the body, and when the body is immune deficient, herpes zoster may occur, which can lead to more severe neuralgia, so it is recommended that this patient can be properly vaccinated against herpes zoster after the age of 50. In addition, when the patient is detected to have hepatitis B virus infection during the perfect examination, it is recommended to follow up and review regularly, at least once every six months, and to carry out antiviral treatment if necessary. In general, pay attention to rest, do not overwork, and avoid unnecessary drug use that may aggravate the burden on the liver.
V. Personal insight
If symptoms such as fever and skin herpes appear, it is recommended to seek medical attention promptly and not to treat them with self-medication, because it is likely that the viral fever is caused by chickenpox, and at this time the patient is highly contagious, and if not treated promptly in isolation, it is likely to be transmitted to others. Early antiviral treatment is still crucial for chickenpox to control the development of herpes and accelerate recovery. Therefore, it is recommended that patients with fever and long herpes seek medical attention without delay to avoid infecting family and friends.