Bullous neonatal varicella, acquired postpartal from a household member, treated successfully with i.v acyclovir: a case report

Neonatal varicella (NV) is extremely rare, with an incidence of 2–6 per 100,000 live births per year, which is often severe and fatal. Bullous NV (BNV) is a rarer variant of varicella. Only 61 cases of NV and 16 cases of BV have been reported; most of them were due to streptococcal infections, also not true bullous varicella; we were not able to find one case of BNV. Herein, we report a case of a 13-day-old male patient presented with severe extensive bullous varicella. On the 9th day postpartum, the mother developed symptoms of a primary varicella zoster virus (VZV) infection while the infant was breastfeeding. Two days later, the infant developed a fever, followed by extensive bullous exanthema involving the entire skin and mucous membranes. He was admitted to the intensive care unit and administered intravenous acyclovir 10 mg/kg/8 h for 7 days and topical fusidic acid/betamethasone cream three times daily. The patient showed prompt improvement and was discharged after 1 week without any sequelae. This is the first case of BNV, treated successfully with only i.v. acyclovir, without VZV IgG or IVIG, which highlights the significance of early intervention with antiviral therapy in neonatal VZV infections.