A Viral Comeback: Recurrent Varicella in A Young Adult Female.

An otherwise healthy young adult female presented to our clinic with a second episode of varicella. Our patient had a diffuse vesicular rash, reminiscent of childhood varicella, accompanied by constitutional symptoms. This rare presentation of a common virus required careful diagnostic and therapeutic decision-making, with a targeted approach based on clinical presentation and risk factors. As this patient was sexually active, there was concern for a mild case of monkeypox or herpes simplex. A polymerase cain reaction test on a skin vesicle was crucial to distinguish between these viral infections and make a diagnosis. With symptomatic treatment, the outcome was favourable. However, internationally recognised practice guidelines do recommend antiviral treatment. Adolescents and adults are at a higher risk of disseminated varicella, with severe and fatal outcomes. Further investigation of underlying immune impairment is also warranted.

Learning points: There are several possible causes of a diffuse vesicular rash in sexually active individuals.Varicella (chickenpox) can occur more than once.A polymerase chain reaction test may be required to distinguish between herpes simplex, varicella zoster and monkeypox infections.