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Mr CP was a 34-year-old man who presented with a 5 day history of fever and generalised malaise, and a 24 h history of an erythematous, non-pruritic rash. In the preceding 2 weeks his two children had contracted similar rashes diagnosed clinically as "chicken pox" (varicella zoster virus, VZV). On the day of presentation, the patient had suffered three episodes of self-limiting, seizure-like activity at home, witnessed by his wife, each lasting around 30 s, separated by several minutes. A fourth episode occurred on transferring to the ambulance. It was described as "grand mal" by ambulance staff, but was also associated with collapse and subsequent loss of carotid pulse. Cardiac monitoring revealed ventricular fibrillation, which was converted to sinus rhythm with one 200 J shock (fig 1). On arrival at the accident and emergency department, his Glasgow Coma Score was 15 and he was cardiovascularly stable. Other than a widespread erythematous, vesicopapular rash covering his upper body, all other examination was normal.
Conversion of patient's ventricular fibrillation to sinus rhythm following a 200 J shock.
Past medical history was unremarkable (with no history of varicella zoster), and he took no regular medications. He smoked 10-20 cigarettes per day with no excessive alcohol intake.
A presumptive diagnosis of VZV infection was made and high dose intravenous acyclovir was prescribed....