eMJA: Prolonged varicella viraemia and streptococcal toxic shock syndrome following varicella vaccination of a health care worker

Notable Cases

Prolonged varicella viraemia and streptococcal toxic shock syndrome following varicella vaccination of a health care worker

Claire M Italiano, Cheryl S Toi, Simon P Chan and Dominic E Dwyer

MJA 2009; 190 (8): 451-453

A 49-year-old health care worker received varicella vaccine in accordance with current Australian guidelines. She developed streptococcal toxic shock syndrome, complicated by acute atraumatic dislocation of the right wrist secondary to poststreptococcal reactive arthritis — to our knowledge, the first report of spontaneous wrist dislocation as a complication in this condition. Vaccination was accompanied by prolonged viraemia with the varicella vaccine strain — also, we believe, the first report of this in an immunocompetent patient.

Clinical record

A 49-year-old female hospital employee received varicella vaccination, in accordance with the guidelines of New South Wales Health for varicella-seronegative health care workers.1 She presented 17 days after the second vaccine dose (38 days after the first dose) with a 12-day history of joint pain and swelling, predominantly affecting the upper limbs and knees, along with myalgia and lethargy. These symptoms had worsened over the preceding 48 hours. There were no noticeable skin lesions, and no local reaction at the vaccination site.

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