PURPURIC CHICKENPOX: REPORT OF A CASE, REVIEW OF THE LITERATURE, AND CLASSIFICATION BY CLINICAL FEATURES
Authors: N. David Charkes
Journal: Annals of Internal Medicine (1961)

Case Reports1 April 1961PURPURIC CHICKENPOX: REPORT OF A CASE, REVIEW OF THE LITERATURE, AND CLASSIFICATION BY CLINICAL FEATURESN. DAVID CHARKESN. DAVID CHARKESSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-54-4-745 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptPurpura is an unusual complication of chickenpox. On the basis of differences in etiology, clinical manifestations, prognosis, and therapy, five major purpuric syndromes may be recognized in this disease : febrile purpura, malignant chickenpox with purpura, postinfectious purpura, purpura fulminans, and anaphylactoid (Schönlein-Henoch) purpura. In addition, bleeding may result from secondary infection, with or without gangrene, or, more rarely, from hemorrhagic nephritis.The purpose of this communication is to report a case of febrile purpura, to review the literature pertinent to bleeding associated with chickenpox, and to delineate the differential features of the major syndromes.CASE REPORTA 26-year-old unmarried...Bibliography1. McGovernDawson JPJF: Purpura fulminans: report of a case coincident with varicella. Clin. Proc. Child. Hosp. 10: 114-118, 1954. MedlineGoogle Scholar2. Stroh M: Zur Klinik der Varicellen mit besonderer Berücksichtigung des Blutbefondes. Z. Kinderheilk. 26: 120-136, 1920. CrossrefGoogle Scholar3. Comby J: Traité des Maladies de l'Enfance. 4th Ed., J. Rueff, Paris, 1902, p. 65. Google Scholar4. Rundle C: A case of hemorrhagic varicella. Lancet 1: 1692, 1906. CrossrefGoogle Scholar5. Andrew J: A case of hemorrhagic varicella and a case of gangrenous varicella. Trans. Clin. Soc. London 23: 79-83, 1890. Google Scholar6. Bérnard D cited by Knowles, F. C.50 Google Scholar7. Baader cited by Knowles, F. C.50 Google Scholar8. Shanks WF: "Haemorrhagic" chicken-pox. Brit. Med. J. 2: 1077, 1922. MedlineGoogle Scholar9. Wanklyn WM: "Haemorrhagic" chicken-pox. Brit. Med. J. 2: 977, 1922. Google Scholar10. Mir J(a) : Un Caso de Varicella Hemorrágica en una niña de tres años. Boll. Soc. cubana de pediat. 10: 457-468, 1938. (b) Raybaud, A., Fantin, J.: La Varicelle Hémorragique et ses Rapports Avec la Leucose Aiguë. Presse méd. 66: 1809-1813, 1958. Google Scholar11. BullowaWishik JGSM(a) : Complications of varicella. I. Their occurrence among 2,534 patients. J. Dis. Child. 49: 923-926, 1935. (b) Bullowa, J. G. M., Wishik, S. M.: Complications of varicella. II. Surface complications. J. Dis. Child. 49: 927-932, 1935. Google Scholar12. MitchellFletcher AGEG: Studies on varicella, age and seasonal incidence, recurrences, complications, and leukocyte counts. J. A. M. A. 89: 279-280, 1927. CrossrefGoogle Scholar13. Beck : Uber das Verhalten der Blutplättchen bei Infektionen. Mschr. Kinderheilk. 29: 673-680, 1924. Google Scholar14. Tocantins LM(a) : The mammalian blood platelet in health and disease. Medicine 17: 155-260, 1938. (b) Malamud, N., Haymaker, W., Custer, R. P.: Heat stroke. Milit. Surgeon 99: 397-449, 1946. CrossrefGoogle Scholar15. Ackroyd JF: Three cases of thrombocytopenic purpura occurring after rubella. Quart. J. Med. 18: 299-318, 1949. MedlineGoogle Scholar16. Perlman EC: Purpuric and cerebral manifestations following measles. Arch. Pediat. 51: 596-604, 1934. Google Scholar17. WilsonDoan SJCA: The pathogenesis of hemorrhage in artificially induced fever. Ann. Intern. Med. 13: 1214-1219, 1940. LinkGoogle Scholar18. MacFarlane RG: Critical review: the mechanism of haemostasis. Quart. J. Med. 10: 1-30, 1941. Google Scholar19. PeckCopley SMAL: Diagnosis and treatment of skin manifestations of capillary fragility. New Engl. J. Med. 235: 900-906, 1946. CrossrefMedlineGoogle Scholar20. Wintrobe MM: Clinical hematology, 3d Ed., Lea and Febiger, Philadelphia, 1951, p. 756. Google Scholar21. Ackroyd JF: Allergic purpura, including purpura due to foods, drugs and infections. Amer. J. Med. 14: 603-632, 1953. CrossrefGoogle Scholar22. van der Burg AP: Changes in the capillary resistance. Acta med. Scand. 146: 448-456, 1953. CrossrefMedlineGoogle Scholar23. Scarborough H: Thrombocytopenia. Postgrad. Med. J. 30: 78-80, 1954. Google Scholar24. Bedson SP: Blood-platelet anti-serum, its specificity and role in the experimental production of purpura. Part II. J. Path. Bact. 25: 94-104, 1922. CrossrefGoogle Scholar25. ElliottWhipple RHMA: Observations on the interrelationship of capillary platelet and splenic factors in thrombocytopenic purpura. J. Lab. Clin. Med. 26: 489-498, 1940. Google Scholar26. Tyzzer EC: The histology of the skin lesions in varicella. J. Med. Res. 14: 361-392, 1905-6. Google Scholar27. Johnson HN: Visceral lesions associated with varicella. Arch. Path. 30: 292-307, 1940. Google Scholar28. Eisenbud M: Chickenpox with visceral involvement. Amer. J. Med. 12: 740-746, 1952. CrossrefMedlineGoogle Scholar29. CheathamWellerDolanDower WJTHTFJC: Varicella: report of two fatal cases with necropsy, viral isolation and serologic studies. Amer. J. Path. 32: 1015-1035, 1956. MedlineGoogle Scholar30. Nicolaides NJ: Fatal systemic varicella, a report of 3 cases. Med. J. Aust. 2: 88-91, 1957. CrossrefGoogle Scholar31. HartmanMajor FWRC: Pathological changes resulting from accurately controlled artificial fever. Amer. J. Clin. Path. 5: 392-410, 1935. CrossrefGoogle Scholar32. von HaamFrost ETT: Changes in the parenchymatous organs produced by artificially induced fever. Proc. Soc. Exp. Biol. Med. 42: 99-103, 1939. CrossrefGoogle Scholar33. Rossman PL: Capillary resistance in artificially induced fever. Ann. Intern. Med. 14: 281-287, 1940. LinkGoogle Scholar34. Frank L: Varicella pneumonitis. Arch. Path. 50: 450-456, 1950. Google Scholar35. Lander H: A case of acute hemorrhagic leukoencephalitis (Hurst) complicating varicella. J. Path. Bact. 70: 157-165, 1955. CrossrefMedlineGoogle Scholar36. BernheimLarbreMouriquandGermain MFCD: Deux cas de Varicelle hémorragique à évolution mortelle chez deux enfants traités à la cortisone pour maladie de Bouillard. Pédiatrie 11: 920-924, 1956. MedlineGoogle Scholar37. VinhCanlorbeGentilLelong LTPCM: La Varicelle Maligne Pluriviscérale. Un cas avec mise en Evidence des Foyers de Nécrose et des Inclusions Acidophiles Intranucléaires. Sem. Hôp. Paris 33: 3889-3992, 1957. Google Scholar38. Landis EM: Capillary pressure and capillary permeability. Physiol. Rev. 14: 404-481, 1934. CrossrefGoogle Scholar39. Levitan BA: The biochemistry and clinical application of vitamin P. New Engl. J. Med. 241: 780-789, 1949. CrossrefMedlineGoogle Scholar40. RobsonDuthie HNJJ(a) : Capillary resistance and adrenocortical activity. Brit. Med. J. 2: 971-977, 1950. (b) Robson, H. N., Duthie, J. J. R.: Further observations on capillary resistance and adrenocortical activity. Brit. Med. J. 2: 994-997, 1952. CrossrefMedlineGoogle Scholar41. Berdan W: The influence of temperature changes on capillary permeability. Med. Arts Sci. 3: 77, 1949. Google Scholar42. BellLazarusMunro GHSHN: Capillary fragility. Lancet 2: 155-157, 1940. CrossrefGoogle Scholar43. KramárMeyersKramár JVWMS: Contribution to the physiology of capillary resistance in the human. J. Lab. Clin. Med. 49: 423-436, 1956. Google Scholar44. ChambersZweifach RBW: Capillary endothelial cement in relation to permeability. J. Cell. Comp. Physiol. 15: 255-272, 1940. CrossrefGoogle Scholar45. IllingworthOliver RWWA: Smallpox in the Middle East. Lancet 2: 681-685, 1944. CrossrefGoogle Scholar46. Storer DH: A case of malignant chickenpox. Boston Med. Surg. J. 1: 212-214, 1828. CrossrefGoogle Scholar47. Hamann cited by Knowles, F. C.50 Google Scholar48. Porter CR: A case of confluent haemorrhagic eruption in varicella. Lancet 1: 1359-1360, 1907. CrossrefGoogle Scholar49. Elliott RW: Hemorrhagic varicella, with report of a case. Cleveland Med. J. 9: 37-40, 1910. Google Scholar50. Knowles FC: Varicella of a hemorrhagic and gangrenous type: report of a fatal case, with a review of the literature. New York J. Med. 93: 876-879, 1911. Google Scholar51. Campbell DG: A case of haemorrhagic chickenpox. Canad. Med. Ass. J. 5: 610-612, 1915. MedlineGoogle Scholar52. de Lemos F: Varicella hemorrhagica. Tribuna Med. 22: 34-36, 1916. Google Scholar53. Vipond AE: Varicella and its complications. Med. Times 57: 87-89, 1929. Google Scholar54. Slim SJ: La Varicella Hémorragique. Thèse, Geneva, 1930. Google Scholar55. TilleyWarin JBJF: A severe case of chickenpox with some unusual features. Brit. Med. J. 2: 1265, 1938. MedlineGoogle Scholar56. FordMarin RARB: Hemorrhagic chickenpox—case report. J. Med. Soc. New Jersey 41: 440-441, 1944. Google Scholar57. Claudy WD: Pneumonia associated with varicella. Arch. Intern. Med. 80: 185-192, 1947. CrossrefGoogle Scholar58. Olesen KH: Om Haemorrhagiske Variceller. Ugeskr. Laeg. 112: 1557-1560, 1950. MedlineGoogle Scholar59. MarsdenCoughlan JPWJ: A case of confluent chickenpox with hemorrhagic symptoms. Brit. Med. J. 1: 1066, 1952. CrossrefMedlineGoogle Scholar60. Josserandde l'Hermuzière PV: Varicelle mortelle à forme hémorragique dans le décours d'un traitement par cortisone-ACTH. Pédiatrie 8: 947-948, 1953. MedlineGoogle Scholar61. VeronesiNeto RVA: Trombocitopenia Aguda no Curso da Varicella. Hospital, Rio de Janeiro 46: 213-220, 1954. MedlineGoogle Scholar62. GhoshKumarPaul MANG: Uneventful recovery in haemorrhagic chickenpox. J. Indian Med. Ass. 25: 180, 1955. MedlineGoogle Scholar63. HeineldLindgren SL: Thrombopenia in childhood. Acta Paediat., Supp. 77: 149-153, 1949. CrossrefGoogle Scholar64. HaggertyEley RJRC: Varicella and cortisone (Letter to the Editor). Pediatrics 18: 160-162, 1956. MedlineGoogle Scholar65. SheeFehrsen JCP: Reactivation of varicella virus by cortisone therapy. Brit. Med. J. 2: 82, 1953. CrossrefMedlineGoogle Scholar66. GuillotClaussede Peretti FJE: Varicelle et Cortisone. Algérie-Méd. 62: 273-245, 1958. MedlineGoogle Scholar67. Nichols WW: Experiences with chickenpox in patients with hematologic disease receiving cortisone. J. Dis. Child. 94: 219-223, 1957. MedlineGoogle Scholar68. Hoffmann W: Ueber Purpura haemorrhagica. Schweiz. med. Wchnschr. 52: 250-252, 1922. Google Scholar69. Tancredi A: Contributo Clinico sopre le Manifistazioni di Porpora nel decorso della Varicella. Pediat. Prat. 10: 221-232, 1933. Google Scholar70. FiessingerMerklenBrouet NFPG: Deux cas d'Aleucie Hémorrhagique. Bull. Soc. Méd. Hop. Paris 50: 98-106, 1934. Google Scholar71. Cohen HJ: Acute thrombocytopenic purpura following varicella. Arch. Pediat. 53: 773-776, 1936. Google Scholar72. RailletGinsbourg B: Purpura et Réaction Leucémoide an décours s'une Varicelle. Bull. Soc. Méd. Hôp. Paris 54: 554-558, 1938. Google Scholar73. StoesserLockwood AVWW: Varicella complicated with acute thrombocytopenic purpura and gangrene. J. Pediat. 12: 641-647, 1938. CrossrefGoogle Scholar74. Gijsberti Hodenpijlvan Lookeren Campagne AKGJ: Een Geval van Haemorrhagische Varicellen. Ned. T. Geneesk. 85: 352-354, 1941. Google Scholar75. CohenBansmer JJC: Chickenpox with simultaneous idiopathic thrombocytopenic purpura. New Engl. J. Med. 237: 222-224, 1947. CrossrefMedlineGoogle Scholar76. Degoulange R: Varicelle avec Thrombopénie. Pédiatrie 6: 734-738, 1951. Google Scholar77. HirschDameshek EOW: "Idiopathic" thrombocytopenia. Arch. Intern. Med. 88: 701-728, 1951. CrossrefGoogle Scholar78. Piaggio BlancoPaseyro RAP: Púrpura Trombocitopénico Agudo con Hemorragia Meníngea, en el curso se una Varicela Común, Curado por la Esplenectomía. An. Fac. Med. Montevideo 36: 55-61, 1951. MedlineGoogle Scholar79. Hansen E: Postinfektøs Purpura som Komplikation til de Almindelige Exantematiske Børnesygdomme. Ugesk. Laeg. 115: 6-11, 1953. MedlineGoogle Scholar80. Welch RG(a) : Thrombocytopenic purpura and chickenpox. Arch. Dis. Child. 31: 38-41, 1956. (b) Beyer, P., Dolle, F., Klein, M.-L.: Purpura Thrombopénique Post-Varicelleux, Revue de la Littérature; à propos d'une observation. Arch. Franç. Pédiat. 15: 920-929, 1958. CrossrefMedlineGoogle Scholar81. ClementDiamond DHLK: Purpura in infants and children. J. Dis. Child. 85: 259-278, 1953. MedlineGoogle Scholar82. Storrie HC: Haemorrhagic and gangrenous varicella, with notes of two cases. Brit. J. Child. Dis. 11: 62-75, 1914. Google Scholar83. Watson TM: Massive skin gangrene complicating chickenpox. J. A. M. A. 102: 2179-2180, 1934. CrossrefGoogle Scholar84. BatchSepkowitz JWS: Varicella complicated by gangrene of the lower extremities. U. S. Armed Forces Med. J. 3: 759-764, 1952. MedlineGoogle Scholar85. StameyManleyLondon CCJHAH(a) : Purpura fulminans following chickenpox. North Carolina Med. J. 17: 115-119, 1956. (b) Crocker, A. M., Middelkamp, J. N.: Varicella gangrenosa. J. Pediat. 54: 104-108, 1959. MedlineGoogle Scholar86. Quick AJ: Hemorrhagic diseases. Lea and Febiger, Philadelphia, 1957, pp. 261-264. Google Scholar87. IllingworthZachary RSRB: Superficial gangrene of the skin in chickenpox. Arch. Dis. Child. 30: 177-179, 1955. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: *Received for publication December 14, 1959.From the U. S. Army Medical Unit, Fort Detrick, Maryland.Requests for reprints should be addressed to N. David Charkes, M.D., Fellow in Medicine, University Hospital, Baltimore 1, Maryland. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byRole of platelets and megakaryocytes in adaptive immunityInfluenza virus H1N1 activates platelets through FcγRIIA signaling and thrombin generationInpatient Rehabilitation of Survivors of Purpura Fulminans With Multiple Limb Amputations: A Case SeriesClassic Viral ExanthemsA Case of Varicella-Associated Idiopathic Thrombocytopenic Purpura in AdulthoodVaricella-Zoster Virus (VZV)An airway management dilemma - gross swelling of the airway associated with haemorrhagic varicella in an adultEpidemiology and clinical manifestations of herpesvirus infections in infants and childrenHerpes zoster-associated idiopathic thrombocytopenic purpura in a liver transplant recipient: a case report and overviewHemorrhagic varicella: A case report and review of the complications of varicella in childrenCutaneous manifestations of systemic infection in childrenChildhood Exanthems: Old and NewCutaneous manifestations of systemic infection in childrenVaricella associated intracerebral hemorrhage in the absence of thrombocytopeniaCase 25-1988Varicella-Zoster Virus Infections Biology, Natural History, Treatment, and PreventionSTEPHEN E. STRAUS, M.D., JEFFREY M. OSTROVE, Ph.D., GENEVIEVE INCHAUSPÉ, Ph.D., JAMES M. FELSER, M.D., ALISON FREIFELD, M.D., KENNETH D. CROEN, M.D., MARK H. SAWYER, M.D.Intravenous gamma globulin therapy for thrombocytopenic purpura associated with active varicella infectionSequential development of platelet, neutrophil and red cell autoantibodies associated with measles infectionMechanisms of thrombocytopenia in varicellaHerpesviruses.Herpes- und verwandte VirenTHROMBOCYTOPENIC PURPURA IN CYTOMEGALOVIRUS MONONUCLEOSISHemorrhagic varicella in parahemophiliaThrombocytopenic Purpura and ChickenpoxFATAL VARICELLA IN AN ADULTThrombocytopenia and Massive Gangrene Following VaricellaDextran Therapy of Purpura FulminansStudies of hemostasis in Thai hemorrhagic feverPurpura Fulminans: Report of a case successfully treated with heparin and hydrocortisone Review of 50 cases from the literatureCorticotropin and Corticosteroids in Human Viral InfectionsModification of Chicken Pox in Family Contacts by Administration of Gamma GlobulinCase 47-1962 1 April 1961Volume 54, Issue 4Page: 745-759KeywordsChickenpoxHemorrhageHemostaticsNephritisPathogenesisPathogensPneumoniaResearch laboratoriesSteroid therapyUrticaria ePublished: 1 December 2008 Issue Published: 1 April 1961 PDF downloadLoading ...