CTICasesDisseminated Varicella Pneumonia with Acute Lung Injury after Double Lung Transplant
[...]. Disseminated Varicella Pneumonia with Acute Lung Injury after Double Lung Transplant. CTICases. Published October 1, 2026. https://cticases.com/c/m5b77
Imaging findings
In a 44-year-old double lung transplant recipient, the initial CT shows scattered small pulmonary nodules typical of infection. About five days later the lungs are much worse, with acute lung injury and an edema-like component in both lungs on top of the infectious nodules. At the same time the patient had skin lesions, which pointed to acute varicella.
Key takeaways
Varicella belongs in the differential for small pulmonary nodules, which can be miliary or larger. Transplant recipients and other immunosuppressed patients are at higher risk of dissemination and can progress to acute lung injury. Skin lesions are the clinical clue. Breakthrough infection or reactivation can occur even in previously vaccinated or previously infected adults because vaccine-derived immunity wanes over time.
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