A 3 year old male with a history of severe eczema presents for facial rash and hand pain. Mom has been applying aquaphor and vaseline several times a day. This morning, he woke up with a new rash over his face and hands which prompted ED visit. Vitals include BP 103/61, HR 156, Temp 102.9F, RR 30, SpO2 99%. Exam is notable for diffuse, dry skin throughout and findings as below. Lesions spare mucous membranes and palms/soles. Nikolsky sign negative. What’s the diagnosis?
Answer: Eczema Herpeticum
- Demonstrated by multiple grouped pustules on an erythematous base
- Typically caused by superinfection of HSV due to a diminished skin barrier from atopic dermatitis
- Commonly misdiagnosed as impetigo
- Potentially life-threatening if has multisystem involvement such as HSV keratitis or encephalitis
- In this case, ophthalmology was consulted to rule out ophthalmologic infection due to extensive rash. Dermatology was consulted for a wound culture which resulted positive for VZV.
- Treatment includes Acyclovir in addition to gram positive coverage such as Bactrim or Cephalexin
American Academy of Pediatrics: Herpes simplex. In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Red Book: 2015 Report of the Committee on Infectious Diseases. 30th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2015:432–445.