When Chickenpox Turns Catastrophic: A Case of Varicella gangrenosum in an Immunocompetent Child

Abstract

Background: Varicella is typically a mild, self-limiting illness in children. However, global data from the World Health Organization estimate more than 4.2 million cases annually requiring hospitalisation and 4,200 deaths, with children comprising the majority. Rare but severe complications, such as varicella gangrenosum (VG), can occur and may have catastrophic outcomes. Case Summary: We report a previously healthy 6-year-old girl with varicella complicated by an extensive gangrenous lesion over the right thigh, septic shock, acute kidney injury and Acinetobacter baumannii sepsis, requiring intensive care support, including mechanical ventilation, inotropic support and surgical debridement. Discussion: Varicella complications may arise from direct viral injury, secondary bacterial infection or immune dysregulation, leading to encephalitis, cerebellar ataxia, pneumonia and skin infections. Risk factors for complications include lack of varicella vaccination, poor hygiene, skin barrier disruption, delayed medical intervention and immunocompromised status. VG is a rare but serious complication of varicella, typically resulting from secondary bacterial infection. Management is multidisciplinary and includes broad-spectrum antibiotics, antiviral therapy, haemodynamic stabilisation and surgical intervention. This case also highlights the importance of early diagnosis and universal varicella vaccination in preventing such outcomes. Conclusion: Varicella gangrenosum, although rare, is a life-threatening complication of varicella. Prompt recognition, aggressive medical management and timely surgical intervention can improve survival. Life-threatening complications may be reduced through enhanced varicella vaccination coverage. Varicella vaccination remains an effective strategy to reduce disease burden and prevent severe outcomes.