Primary varicella infection associated with Steven-Johnson syndrome

Steven-Johnson Syndrome (Erythema Multiforme Major) is a severe occasionally fatal variant of Erythema Multiforme which is abrupt in onset accompanied by fever, malaise, headache and erosions of conjunctiva, mouth and genitilia with skin lesions in the form of erythematous macules, papules and target lesions involving less than 10% of body surface area. Varicella is caused by varicella zoster virus. It is a primary infection with a viraemic stage after which the virus persists in the sen-sory nerve ganglia cells, reactivation of which in the later life re-sults in herpes zoster. Varicella is transmitted by droplet infection. Patients are usually infectious 2 days prior to 5 days after the on-set of rash. Varicella confers lasting immunity and second attacks are uncommon in immunocompetent individuals. Immunoglobulin(Ig), IgG, IgM, IgA antibodies appear in about 1 week after the onset and the peak levels occur during the second and third week thereafter the titred gradually fall.Immunoglobulins have incomplete protective effect, CMI is more important against the infection and if the primary infection occurs when CMI is impaired as in organ transplant patients it maybe fatal.We, report a rare association of primary varicella with Steven Johnsons Syndrome successfully treated with a combination of systemic steroids and Acyclovir.