Eczema herpeticum, kapoși varicelliform eruption – case report

Abstract

Eczema herpeticum (EH) is a viral infection, which occurs as a complication in patients with atopic dermatitis (AD). Infants and children are more commonly affected. The clinical diagnosis is established based on the anamnesis of atopic dermatitis, the presence of acute, monomorphic rash, composed of grouped, painful vesicles, associated with fever and fatigue. The site of choice is the face and neck, but it can also be generalized. Laboratory tests include: viral culture, direct staining with fluorescent antibodies, Polymerase chain reaction, Tzank cell test. Treatment includes antiviral preparations, antiseptics and topical corticosteroids (CS) [1,3]. Aim The case is intended to represent the association of EH and DA, with the distinct morphological particularity of the lesions and the use of systemic CS as treatment. Case report Patient X, 18 years old, presents with multiple papules, vesicles, crusts, predominantly periorbital, intensely painful (7/10 periorbital), accompanied by itching and sero-purulent discharge from the conjunctival sac. The history of the disease continues for 2 years, with the primary appearance of rashes on the face and conjunctiva. The self-treatment included creams and eye drops based on CS, with a temporary positive effect, which is why he was admitted to the dermatology department. From the anamnesis, the patient is known to have DA and allergic conjunctivitis, allergic to cephalex. Parents allergic to ragweed, siblings suffer from DA. The dermatological status manifested by chronic lesions in exacerbation, inflammatory type, symmetrical on the face, primarily periorbital, polymorphic, represented by papules and vesicles placed in clusters with an erythematous background, covered by miliceric adherent crusts and sero-purulent exudate, intensely pruritic and painful. Paraclinical investigations revealed: VSH, total IgE, bacteriological examination St. Aureus, Anti HSV type 1 IgG, Tzanck cell test - positive. Based on the anamnestic data, the clinical and paraclinical examination, the diagnosis of Eczema Herpeticum, and Kaposi varicelliform eruption was established. Systemic treatment with Valaciclovir 500 mg, 3 pills/day, Prednisolone 5 mg, 7 pills/day, Clemastin-BP 1 mg, Ketotifen 1 mg, Microflox- 500 mg, Furosemide 40 mg and topical antiseptics, zinc oil 30%. Discussions The clinical case demonstrates that the complications of atopic dermatitis can be an exacerbation of herpetic infection that can be easily missed. The increased expression of T-helper type 2, IL-10 and IL-25 in patients with Eczema herpeticum, is associated with the decrease of antimicrobial peptides in the epidermis and the increase of local inflammation, which decreases the protective forces against herpetic infection [2]. Conclusion The peculiarity of the presented case consisted in the manifestation of the polymorphic eruption with the appearance of papules and vesicles that are not classic in EH. Another particularity was the use of systemic versus topical CS, to prevent the rebound effect. The association of herpes infection with AD is a potentially fatal condition. In our case, only facial localization and a positive therapeutic response imply a favorable prognosis, but with possible recurrences.