Background Haemorrhagic varicella is a serious complication of a relatively benign disorder and usually occurs in immunocompromised persons and those on immunosuppressive therapy. We report a case of Haemorrhagic Chicken Pox in a 4 year old boy who had previously been immunised with chicken pox vaccine.

Case presentation A previously fit and well 4-year-old boy of Chinese origin presented with poor oral intake after having a 3 day history of a spreading vesicular rash. The rash had initially started on his mouth and proceeded to spread to his face, body and limbs. On examination, the worse affected areas were his mouth and genitals. On day 3 of this illness, the vesicles burst and started bleeding. He diagnosed as haemorrhagic varicella on examination and was started on intravenous Aciclovir, flucloxacillin and ceftriaxone and chloramphenicol eye drops (due to a secondary conjunctivitis). He was noted to have various necrotic areas throughout his body and required regular opioid analgesia to manage his pain and discomfort. His condition gradually improved and he was discharged home after 2 weeks. He had previously been given the Varicella vaccine as a baby whilst in America, and had not had chicken pox prior to this. Immunoglobulins done during his admission were normal and VZV IgG antibodies were also detected via PCR.

Discussion Varicella-Zoster virus (VZV) infection is characterised by the appearance of a generalised vesicular rash. The vaccine for VZV has been available since 1974, and has been shown to be very effective in the prevention of the disease and its severe complications.

The prevalence of severe complications of Varicella in the UK is 0.86/100000. Haemorrhagic varicella is a condition that more commonly affects immunocompromised patients, although there have been reports of it affecting seemingly well children. This case highlights an extreme response of varicella in a well child who had previously been immunised to VZV. Prompt diagnosis and treatment with aciclovir leads to complete recovery.

Learning points Haemorrhagic varicella is a serious complication of chicken pox and needs prompt diagnosis and treatment with aciclovir.