chickenpox is disease caused by varicella - zoster virus ( vzv ) , with possibly devastated consequences during pregnancy , for mother and neonate . a 39-year - old female in third trimester twin pregnancy , referred to clinic for infectious diseases in sarajevo , with five days history of illness . before the admission her condition get worse , with fatigue , exhaustion , and shortness of breath . in a first three days patient was febrile , tachydispnoic and ortopnoic . varicella pneumonia during third trimester may have serious consequences for mother and child , with possible fatal outcome . chickenpox ( varicella ) is childhood disease that usually passes without complication in immunocompetent adults and children . but , in recent states , such as immunodeficiency or pregnancy , it can cause serious complications . smokers , men and immunocompromised individuals may have a greater risk of contracting the disease , and pregnant women have risk of greater morbidity and mortality . chickenpox may have significant consequences for pregnant women and neonate , since it can progress to pneumonia that compromise viability of the fetus . a 39 years old female smoker , in a high grade twin pregnancy , referred to clinic for infectious diseases with five days history of illness . in a first two days she had a high temperature , up to 38.8oc , and later she noticed she visited general practicioner and specialist for infectious diseases , with suggestion to take symptomatic therapy . before the admission in hospital her condition get worse , with fatigue , exhaustion , and shortness of breath . the patient did not have a history of chickenpox during childhood but her son developed chickenpox 10 days earlier . the patient was febrile ( 39.2c ) , tachypnoic ( respiratory rate 30 breaths / min ) , tachycardic ( cardiac pulse 110/min ) , pale and sweaty . she had typical chickenpox vesicles with some pustules over the face , neck , torso and abodmen . blood tests show high c - reactive protein ( crp ) , normal leukocytes and differential blood count , with low platelets . in a first three days patient was febrile up to 39.3oc , tachydispnoic and ortopnoic , with bullosus rash over the trunk . fourth day of hospital stay we noticed detoriation in patient s condition , with intensive chest pain , bloody cough and intermittent disorientation and dominant tachypnea ( over 40/min ) . ct confirmed billateral infiltration with signs of alveolo - interstitial syndrome , with massive inflammatory changes . antimicrobial therapy was changed to vancomycin and rifampicin , corticosteroids are associated ( hydrocortison ) , with cardiotonic , diuretic , albumin infusions , pantoprasole , heparin and continuous oxygenation on facial mask . after 19 days of intesive care in our clinic , patient was transferred to clinic for gynecology and obstretition where artefitial abrubtion has been completed . on follow - up after 14 days patient was in good condition , with normal chest x - ray and blood tests . pregnancy carries a special risk of getting chickenpoxnot only for mother but also for the baby . varicella - zoster infection occuring in a period of pregnency is related with increased risk of spontaneus abortion and congenital and foetal infection ( 1 ) . also , low level of oxygen in blood during severe cases of pneumonia carries risk of neurological sequelas for babies . our patient was smoker , and cigarette smoking was recognized as a major risk factor for developing vzv associated pneumonia in adults ( 2 ) . incidence of pneumonia , as a complication of varicella in pregnancy , varies from 1/2000 to 1/10000 . early studies indicate that varicella pneumonia developing in third trimester carries risk of higher mortality ( 3 ) . fetal complication of vzv infection include early delivery , fetal varicella syndrome and neonatal varicella . the risk of congenial abnormalities is 0.2 - 2% for mothers who contract varicella in first two trimesters of pregnancy , and maternal varicella may cause herpes zoster in early childhood ( 4 ) . early manifestation of herpes zoster may be explained with immature cellular immunity and low level of maternally delivered antibodies . symptomatic therapy is first choice of treatment , but in some cases antiviral and antimicrobic therapy is necessary . acyclovir , nucleozide analogue that inhibits viral dna polymerase , is helpful in the management of varicella pneumonia . it cross the placenta , but no teratogenic effects have been observed in conducted studies . before introduction of specific antiviral agents case - fatality rate of maternal varicella pneumonia was up to 41% . some authors reported good response to corticosteriods , while others considere them contraindicated in pregnancy ( 6 ) . varicella - zoster immunoglobulin ( vzig ) is product that contains varicella zoster immunoglobulin g , derived from donors with high titers of antibodies . it is usually given to infants when mother develops chickenpox within five days after birth . another indication is for pregnant woman with unclear history of chickenpox , or unknown antibody status . optimum protection is obtained when vzig is administred within 96 hours of exposure , in a dose of 125u/10 kg or maximum of 625u for adults , although some guidelines suggest that it can be administred up to 10 days after exposure ( 7 ) . vzig may reduce severity of disease , but not always prevent congenital or neonatal infection . other option to prevent chickenpox varicella vaccine is available more than 20 years , and active immunisation in some countries significantly reduced hospitalisation and complication rate ( 8) . varicella pneumonia , as most common complication during chickenpox , have a significant impact to pregnant woman and their babies . in order to reduce incidence of chickenpox and prevent complications in pregnant woman
summaryconflict of interest : none declared.introductionchickenpox is disease caused by varicella - zoster virus ( vzv ) , with possibly devastated consequences during pregnancy , for mother and neonate . 
 pneumonia is most common complication in pregnancy with very high mortality.case reporta 39-year - old female in third trimester twin pregnancy , referred to clinic for infectious diseases in sarajevo , with five days history of illness . before the admission 
 her condition get worse , with fatigue , exhaustion , and shortness of breath . in a first three days patient 
 was febrile , tachydispnoic and ortopnoic . 
 we started therapy with acyclovir and antibiotic . 
 after four days we had detoriation in patient s condition . 
 chest x - ray revealed infiltrative shadows in basal parts of lung . 
 antimicrobial therapy was changed and corticosteroids were associated . 
 significant improvement was noticed after five days of therapy.conclusionvaricella pneumonia during third trimester may have serious consequences for mother and child , with possible fatal outcome .