The following viral infection occurs with increased frequency in patients with Hodgkin's disease:
a. Clinically, chickenpox presents as a rash, low-grade fever, and malaise, although a few patients develop a prodrome 1–2 days before onset of the exanthem.
b. In the immunocompetent patient, chickenpox is usually a benign illness associated with lassitude and with body temperatures of 37.8°–39.4°C (100°–103°F) of 3–5 days' duration.
c. The skin lesions—the hallmark of the infection—include maculopapules, vesicles, and scabs in various stages of evolution.
d. These lesions, which evolve from maculopapules to vesicles over hours to days, appear on the trunk and face and rapidly spread to involve other areas of the body.
e. Most are small and have an erythematous base with a diameter of 5–10 mm. Successive crops appear over a 2- to 4-day period.
f. Lesions can also be found on the mucosa of the pharynx and/or the vagina.
g. Younger children tend to have fewer vesicles than older individuals.
h. Secondary and tertiary cases within families are associated with a relatively large number of vesicles.
i. Immunocompromised patients—both children and adults, particularly those with leukemia—have lesions (often with a hemorrhagic base) that are more numerous and take longer to heal than those of immunocompetent patients.
j. Immunocompromised individuals are also at greater risk for visceral complications, which occur in 30–50% of cases and are fatal 15% of the time in the absence of antiviral therapy.