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Year : 2018  |  Volume : 17  |  Issue : 2  |  Page : 96-97  

Secondary infection of preaxial polydactyly following varicella infection


1 Department of Orthopaedics, Government Medical College, Haldwani, Uttarakhand, India
2 Department of Pathology, Government Medical College, Haldwani, Uttarakhand, India

Date of Web Publication13-Mar-2018

Correspondence Address:
Dr. Ganesh Singh Dharmshaktu
Department of Orthopaedics, Government Medical College, Haldwani - 263 139, Uttarakhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aam.aam_42_17

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How to cite this article:
Dharmshaktu GS, Pangtey T. Secondary infection of preaxial polydactyly following varicella infection . Ann Afr Med 2018;17:96-7

How to cite this URL:
Dharmshaktu GS, Pangtey T. Secondary infection of preaxial polydactyly following varicella infection . Ann Afr Med [serial online] 2018 [cited 2019 Oct 20];17:96-7. Available from: http://www.annalsafrmed.org/text.asp?2018/17/2/96/227179

Sir,

Varicella or chickenpox infection is caused by varicella-zoster virus and usually has benign, contagious course with characteristic exanthematous, vesiculobullous lesions mostly in childhood.[1] Secondary bacterial infections of skin and soft tissues are most common complications of chickenpox and may range from 2% to 5% of all cases.[2] Musculoskeletal complications are rare but at times morbid as mostly lead to acute osteomyelitis and septic arthritis. Only five cases were complicated to osteomyelitis in two studies with cumulative pool of 297 cases of German and Turkish region.[3],[4] Other notable musculoskeletal complications are necrotizing fasciitis, deep tissue abscess, toxic shock syndromes, multifocal arthritis, pyomyositis, and necrotizing pyomyositis.[5],[6]

A 6-year-old male child was brought to us alongside parents with painful, swollen right extra thumb (preaxial polydactyly). No regional- or systemic-associated anomaly was noted, and the symptoms of the extra digit were preceded by chickenpox infection a week earlier. There was the presence of characteristic rash of chickenpox at different stages of evolution in extremities and trunk. There was also a rash present over the swollen extra digit [Figure 1]a. The extra digit showed purulent collection at its base the next day [Figure 1]b. The deformity of the thumb was congenital and solitary. The anomalous digit was connected to the thenar region with a thin soft tissue stalk and was sensate but nonfunctional. Severe throbbing pain due to secondary infection, swollen nonfunctional digit, and possibility of complicating into the ischemic necrosis were reasons for opting the amputation of the digit and the surgery was done following parental consent [Figure 2]. No local immediate or remote complication was noted in postoperative period till the follow-up of 7 months.
Figure 1: The image of affected extra digit (preaxial polydactyly) with inflammation. The presence of typical varicella rash over the affected digit (a) and the suppuration near base of digit the following day (b)

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Figure 2: Clinical image following removal of the digit and healing of the localized infection

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Musculoskeletal complications of varicella require prompt recognition, diagnosis, and treatment as some of them may prove life- or limb-threatening. Secondary skin and soft tissue infections and cases of osteomyelitis are also reported.[7] Group A streptococcal infection predominates musculoskeletal cases and its profile is aggravating with time.[8] The culture of postamputated digit and pus was negative in our case. The advance investigations could not be done due to financial issues. In our case, associated vasculopathy, a well-described complication, may have led to the aforementioned secondary infection or both as a small stalk was connecting the digit with thenar region. Both primary infection and reactivation of infection can cause vasculopathies and may lead to tissue infarction in uni- or multifocal manner. Coagulopathy-related disorders were noted in cases with purpura fulminans as postvaricella complications with immune-related protein S deficiency leading to disseminated intravascular coagulation.[9] Associated vasculitis or thrombosis are other causes of thrombotic events postvaricella infection and may lead to limb amputation.[10] A cautious approach is warranted in dealing with cases of varicella infection, and knowledge of rarer complications is beneficial.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Mueller NH, Gilden DH, Cohrs RJ, Mahalingam R, Nagel MA. Varicella zoster virus infection: Clinical features, molecular pathogenesis of disease, and latency. Neurol Clin 2008;26:675-97, viii.  Back to cited text no. 1
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2.
Choo PW, Donahue JG, Manson JE, Platt R. The epidemiology of varicella and its complications. J Infect Dis 1995;172:706-12.  Back to cited text no. 2
    
3.
Ziebold C, von Kries R, Lang R, Weigl J, Schmitt HJ. Severe complications of varicella in previously healthy children in Germany: A 1-year survey. Pediatrics 2001;108:E79.  Back to cited text no. 3
    
4.
Koturoglu G, Kurugöl Z, Cetin N, Hizarcioglu M, Vardar F, Helvaci M, et al. Complications of varicella in healthy children in Izmir, Turkey. Pediatr Int 2005;47:296-9.  Back to cited text no. 4
    
5.
Schreck P, Schreck P, Bradley J, Chambers H. Musculoskeletal complications of varicella. J Bone Joint Surg Am 1996;78:1713-9.  Back to cited text no. 5
    
6.
Mills WJ, Mosca VS, Nizet V. Orthopaedic manifestations of invasive group A streptococcal infections complicating primary varicella. J Pediatr Orthop 1996;16:522-8.  Back to cited text no. 6
    
7.
Ertvaag GM, Haakonsen MO, Gudmundsen TE, Hoyer H, Solheim DM. Osteomyelitis as a complication of varicella. Tidsskr Nor Laegeforen 1998;118:4515-6.  Back to cited text no. 7
    
8.
Gupta AK, Bonajmah AA. Varicella-related musculoskeletal complications in children. J Pediatr Orthop B 2011;20:264-9.  Back to cited text no. 8
    
9.
Fluri S, Kaczala GW, Leibundgut K, Alberio L. Chickenpox is not always benign: Postvaricella purpura fulminans requires prompt and aggressive treatment. Pediatr Emerg Care 2010;26:932-4.  Back to cited text no. 9
    
10.
Peyton BD, Cutler BS, Stewart FM. Spontaneous tibial artery thrombosis associated with varicella pneumonia and free protein S deficiency. J Vasc Surg 1998;27:563-7.  Back to cited text no. 10
    


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