A case of a rare and serious skin infection - Eczema Herpeticum

Dr.Giuseppe Micali and associates have reported a case of Eczema Herpeticum that has appeared in NEJM.

In the present case an 8-year-old girl with atopic dermatitis presented with a 3-day history of a diffuse eruption of pruritic, umbilicated, erythematous vesicles with erosion and crusting on the flexor surfaces of the legs and arms. Her parents reported that eczematous lesions had previously occurred in these locations.

On examination, the patient was found to be afebrile, and no lymphadenopathy was present. A vesicle was unroofed, and cytologic analysis of the fluid revealed giant ballooned keratinocytes that were consistent with herpes virus infection. A direct fluorescent antibody test was positive for herpes simplex virus (HSV) type 1.

Courtesy NEJM

The patient received a diagnosis of eczema herpeticum, an eruption of a viral infection on a preexisting site of skin disease — typically, atopic dermatitis. Eczema herpeticum is most commonly caused by HSV. The differential diagnosis includes impetigo, bullous impetigo, scabies, eczema vaccinatum, and primary varicella infection.

Bacterial superinfection is an important consideration. Eczema herpeticum can be severe and in some cases life-threatening. Early diagnosis and systemic antiviral treatment can minimize complications. The patient was treated with acyclovir, and the lesions healed completely after 3 weeks.

Carry home message is that atopic dermatitis is the most common diagnosis in the outpatient department for pediatric dermatology may be associated with HSV infection. Therefore the patients should be carefully examined for secondary herpes virus infection owing to the high mortality rates associated with it.

For more details click on the link: DOI: 10.1056/NEJMicm1701668