Late-Pregnancy Varicella Infection Treated With Oral Acyclovir: A Case Report Of Favorable Maternal And Neonatal Outcomes

Abstract

We report the case of a 42 year old woman at 36 weeks of gestation with primary varicella infection. She is presented with a 2 day history of vesicular rash starting on the face and spreading to the trunk and extremities. The symptoms preceded by fever, headache, pruritus, and malaise. She had no prior similar illness and had recent close contact with her child who had active varicella. Physical examination showed lesions in various stages of evolution, the fetal heart rate was within reassuring range, and the fetus was in transverse lie. Tzanck smear revealed multinucleated giant cells, supporting the diagnosis of varicella. The patient received 7 days of oral acyclovir, paracetamol, loratadine, and topical fusidic acid. The patient showed gradual improvement in fever, pruritus, and lesion healing. At 37 weeks, she underwent cesarean section for transverse lie in labor. The neonate was healthy, with no congenital anomalies or neonatal varicella. This report may also be relevant to other low-resource settings where intravenous antiviral therapy is not available. The findings suggest that oral acyclovir can be considered for varicella management in pregnant women, particularly in contexts with limited access to intravenous antivirals. Furthermore, the case highlights the potential risk of varicella in pregnant women without prior immunity, emphasizing the importance of public education on varicella transmission and pre-pregnancy vaccination as preventive measures.