Simultaneous primary infection with varicella zoster and Epstein-Barr viruses.

A previously healthy 6 year old boy was admitted with a two day history of slight fever and sore throat. According to his mother he had had chickenpox at the age of 2, but otherwise he had been in perfect health. During the weeks before his illness there had been a small epidemic ofvaricella at the day care centre which he attended. Physical examination on admission showed generalised enlargement of the lymph nodes, especially on the anterior aspect of the neck. The tonsils were swollen with a white exudate, and a moderate hepatosplenomegaly was also found. His temperature was 37-7'C. No exanthema was noted. A preliminary clinical diagnosis of infectious mononucleosis was made, and he was sent home. Two days later he was admitted to hospital because of a rise in temperature (39-5'C) and inadequate fluid intake. One day before readmission a sparse generalised vesicular exanthema had developed. The lesions were about 1 cm in diameter and contained serous fluid. An indirect immunofluorescence test of vesicle fluid showed varicella zoster virus antigen. Results of laboratory investigations on admission were: haemoglobin 116 g/l, leucocytes 15 0x 10/1(20% neutrophils, 76% lymphocytes, and 4% monocytes). Atypical lymphocytes were also found. Erythrocyte sedimentation rate was 32 mm in the first hour, an4 C reactive protein concentration was 50 mg/l (normal value <10 mg/l). Serum creatinine concentration was normal (47 ttmol/l). Blood cultures yielded negative results, and virus isolation from the nasopharynx was also negative. The results ofa Paul-Bunnel test performed two days after the onset of illness was positive (titre 1/160).The table shows antibody titres to varicella zoster and Epstein-Barr viruses.