Objective:

To report a rare case of Staphylococcus aureus lung abscess following neonatal varicella in a preterm infant and highlight the importance of early pathogen identification and individualized antimicrobial therapy.

Approach:

• Case Presentation: A 26-day-old preterm infant developed respiratory distress and skin lesions after maternal varicella exposure. Initial treatments included topical care and intravenous acyclovir, followed by identification of Staphylococcus aureus via respiratory metagenomic next-generation sequencing.

Key Findings:

• The infant presented with extensive skin lesions and respiratory distress requiring non-invasive ventilation.
• Chest imaging revealed a right upper lobe abscess, and blood cultures were negative.
• Initial treatment with vancomycin was ineffective, leading to a switch to linezolid, resulting in clinical improvement.

Interpretation:

The case illustrates that resolution of skin lesions does not exclude deep-seated infections and emphasizes the need for imaging in persistent respiratory abnormalities.

Limitations:

• The rarity of the condition limits generalizability.
• The case is based on a single patient experience.

Conclusion:

This case underscores the importance of early recognition and tailored antimicrobial management in high-risk neonates with complications from neonatal varicella.