Wazir HU, Ullah I, Dad A, Khattak Z, Humaira, Naz S, Kamil KA. Neonatal varicella zoster transmission from mother, management in a resource-limited setting: A case report. World J Clin Pediatr 2026; 15(3): 118387 [DOI: 10.5409/wjcp.118387]
Corresponding Author of This Article
Kamil Ahmad Kamil, MD, Chief Physician, Consultant, Department of Internal Medicine, Mirwais Regional Hospital, Shahre-Naw, Kandahar 3801, Kandahār, Afghanistan. drkamilahmad1@gmail.com
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Pediatrics
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case-report
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Wazir HU, Ullah I, Dad A, Khattak Z, Humaira, Naz S, Kamil KA. Neonatal varicella zoster transmission from mother, management in a resource-limited setting: A case report. World J Clin Pediatr 2026; 15(3): 118387 [DOI: 10.5409/wjcp.118387]
World J Clin Pediatr. Sep 9, 2026; 15(3): 118387 Published online Sep 9, 2026. doi: 10.5409/wjcp.118387
Neonatal varicella zoster transmission from mother, management in a resource-limited setting: A case report
Hakim Ullah Wazir, Inayat Ullah, Ali Dad, Zainab Khattak, Humaira, Sadaf Naz, Kamil Ahmad Kamil
Hakim Ullah Wazir, Department of Medicine, Lady Reading Hospital, Peshawar 25000, Khyber Pakhtunkhwa, Pakistan
Inayat Ullah, Department of Pediatrics, Gujju Khan Medical College, Swabi 35100, Khyber Pakhtunkhwa, Pakistan
Ali Dad, Zainab Khattak, Humaira, Sadaf Naz, Department of Medicine, Gujju Khan Medical College, Swabi 35100, Khyber Pakhtunkhwa, Pakistan
Kamil Ahmad Kamil, Department of Internal Medicine, Mirwais Regional Hospital, Kandahar 3801, Kandahār, Afghanistan
Kamil Ahmad Kamil, Medical Faculty, Malalay Institute of Higher Education, Kandahar 3802, Kandahār, Afghanistan
Author contributions: Wazir HU contributed to conceptualization, investigation, writing – original draft, preparation; Ullah I contributed to supervision; Hateef AD contributed to formal analysis, data collection; Humaira contributed to visualization, project administration; Kamil KA contributed to corresponding author responsibilities; Wazir HU and Naz S contributed to data curation; Ullah I, Khattak Z, and Kamil KA contributed to writing – review & editing; Ullah I and Naz S contributed to resources; Khattak Z and Kamil KA contributed to validation.
AI contribution statement: AI-based tools (e.g., ChatGPT and/or Grammarly) were used to assist with minor language refinement and to improve clarity and readability.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Kamil Ahmad Kamil, MD, Chief Physician, Consultant, Department of Internal Medicine, Mirwais Regional Hospital, Shahre-Naw, Kandahar 3801, Kandahār, Afghanistan. drkamilahmad1@gmail.com
Received: December 31, 2025 Revised: January 27, 2026 Accepted: March 9, 2026 Published online: September 9, 2026 Processing time: 213 Days and 8.4 Hours
Abstract
BACKGROUND
Neonatal varicella is a rare but potentially life-threatening condition resulting from vertical transmission of varicella-zoster virus from mother to newborn in the last 3 weeks of pregnancy or acquired after few days of delivery.
CASE SUMMARY
We present a case of a 15 days old male neonate who contracted varicella within the first two weeks of life, born to a mother with unvaccinated status and exposure to varicella zoster infection within family. Diagnosis was made clinically based on the characteristic rash all over the body and fever, despite the unavailability of gold standard diagnostic tests like polymerase chain reaction. In the absence of varicella-zoster immunoglobulin (VZIG), the neonate was successfully managed with intravenous acyclovir, antibiotics and supportive care. Prompt initiation of antiviral therapy and meticulous supportive care led to a favourable outcomes. This case demonstrates that: (1) Clinical diagnosis of neonatal varicella zoster can be made based on characteristic rash in the absence of gold standard diagnostic tests, facilitating timely management in resource-limited settings; (2) Intravenous acyclovir therapy, in combination with antibiotics and supportive care, is an effective treatment when VZIG is unavailable; and (3) Early recognition and prompt antiviral therapy is crucial in preventing complications and improving outcomes in affected newborns.
CONCLUSION
This case highlights the importance of clinical acumen in diagnosing neonatal varicella and the effectiveness of acyclovir therapy in resource-limited settings, where access to advanced diagnostic tests and specific immunoglobulins may be restricted.
Core Tip: This case report highlights the critical management of neonatal varicella in a resource-limited setting where standard interventions like varicella-zoster immunoglobulin and polymerase chain reaction testing are unavailable. It demonstrates that a timely clinical diagnosis based on characteristic rash and maternal history, coupled with prompt intravenous acyclovir therapy and meticulous supportive care, can lead to a favourable outcome. The case underscores the importance of clinical acumen and accessible antiviral treatment as effective alternatives for managing this life-threatening condition when advanced resources are constrained.
