Gangrenous Chickenpox with Atypical Clinical and Histopathological Findings.

The primary infection with VZV usually occurs with typical clinical features. Nevertheless, atypical lesions (necrotic, verrucous, and polymorphic light eruption-like lesions) have been described, especially in immunocompromised subjects or patients with hemopathies or undergoing hemodialysis. Our patient presented necrotic synchronous lesions not involving the scalp, resembling monkeypox infection. However, RT-PCR for monkeypox resulted negative, and immunodeficiencies and hemopathies were excluded. In our case, histopathological findings revealed necrosis and neutrophilic infiltrate, similar to those observed in pityriasis lichenoides et varioliformis acuta (PLEVA), while the typical chickenpox aspects (intraepidermal blister, acantholysis, lymphoid infiltrates, and viral cytopathic effects) were slightly represented. Cases with clinical and histological findings compatible with PLEVA, associated with VZV isolated from blood or skin, are rarely reported in the literature. Nevertheless, in our patient, the rapid healing after acyclovir treatment led us to perform a diagnosis of atypical and gangrenous chickenpox.