Kramer, Thomas, Tyler, and Elston report no conflict of interest. The authors report discussion of off-label use for intravenous vaccinia immune globulin under an investigational new drug protocol. Kramer and Thomas are residents from the Department of Dermatology, Dr. Tyler is an Associate in Pathology, and Dr. Accepted for publication December 23,
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Kramer, Thomas, Tyler, and Elston report no conflict of interest. The authors report discussion of off-label use for intravenous vaccinia immune globulin under an investigational new drug protocol.
Kramer and Thomas are residents from the Department of Dermatology, Dr. Tyler is an Associate in Pathology, and Dr. Accepted for publication December 23, Disseminated herpes or vaccinia in the setting of underlying skin diseases is known as Kaposi's varicelliform eruption KVE. Patients typically present with disseminated vesicopustules in the areas of the most severe involvement of their underlying skin disease.
We report a case of eczema herpeticum in a woman with a long-standing history of atopic dermatitis AD. This report also reviews the literature on eczema herpeticum and eczema vaccinatum EV , summarizes clinical and histopathologic characteristics and treatment, and discusses the recommendations of the Centers for Disease Control and Prevention for smallpox vaccination.
Patients with chronic inflammatory skin diseases, particularly atopic dermatitis AD , are at risk for dissemination of cutaneous viral infections. Infection is most commonly caused by herpes simplex virus HSV ; however, it also may occur with coxsackievirus or vaccinia. When KVE occurs in a patient who has received or has come in close contact with someone who has received the smallpox vaccination, it also is referred to as eczema vaccinatum EV.
The pathogenesis of KVE may be related to impaired immune surveillance or simply may represent a mechanical phenomenon secondary to decreased epithelial barrier function. As the threat of bioterrorism with smallpox increases, physicians must address the question of safety when vaccination is considered in individuals with a history of atopy. A year-old woman with long-standing AD presented with a 5-day history of painful vesicles that had started on her right arm and gradually spread to involve the rest of her body.
She had been evaluated by a physician and had been placed on prednisone, cephalexin, and triamcinolone without improvement. The patient did not have any preceding history of oral ulcerations or erosions but did report a history of intermittent "cold sores.
A diagnosis of eczema herpeticum was made, and treatment with valacyclovir and cephalexin was initiated. Results of a bacterial culture yielded Staphylococcus and Streptococcus species. Biopsy results confirmed cytopathic changes diagnostic of herpesvirus infection with focal keratinocyte necrosis and acantholysis Figures 4 and 5.
The literature presents conflicting data regarding immunologic defects in response to herpesvirus infection in patients with AD. Although it has been suggested that patients with AD have depressed cell-mediated immunity to HSV, studies have failed to confirm this. KVE can present in a primary form or a recurrent form. Recurrent cases usually are more limited with fewer systemic symptoms.
Herpetic keratitis is a serious ocular sequela. Fortunately, despite the frequent involvement of vesicopustules on the face, ocular herpetic infection is rare in the setting of KVE.
Skip to main content. Coronavirus News Center. Author and Disclosure Information Drs. Sasha C. Kramer, MD; Chadwick J. Thomas, MD; William B. Tyler, MD; Dirk M. Elston, MD Accepted for publication December 23, Case Report A year-old woman with long-standing AD presented with a 5-day history of painful vesicles that had started on her right arm and gradually spread to involve the rest of her body. Differential Diagnosis and Diagnosis.
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Eczema Herpeticum (Kaposi Varicelliform Eruption)
DermNet provides Google Translate, a free machine translation service. Note that this may not provide an exact translation in all languages. Eczema herpeticum is a disseminated viral infection characterised by fever and clusters of itchy blisters or punched-out erosions. Most cases of eczema herpeticum are due to Herpes simplex type 1 or 2. Signs appear 5—12 days after contact with an infected individual, who may or may not have visible cold sores. Eczema herpeticum may also complicate recurrent herpes. However, repeated episodes of eczema herpeticum are unusual.
Kaposi's Varicelliform Eruption: A Case Report and Review of the Literature
Kaposi's varicelliform eruption is a rare and potentially fatal viral infection caused mainly by reactivation of herpes simplex virus. It concomitantly occurs with pre-existing skin conditions, mostly atopic dermatitis, so it is predominately found in children. We present a case series that includes four adults, familial cases, and previously healthy patients. We also highlight clinical features, associations and therapeutic options.
Kaposi's Varicelliform Eruption
Sudden onset of a painful vesicular rash in a patient with a preexisting skin condition should alert you to the diagnosis of eczema herpeticum EH. These generally occur in the setting of a background dermatosis. The eruption may coalesce into large denuded areas that can be secondarily infected. Patients typically have associated fever and malaise. Continue Reading. Typical vesicles and punched out erosions on face and torso.
London, Ont. Canada; Toronto. In the present communication, two cases of Kaposi's varicelliform eruption occurring in adults will be described. The first ended fatally, and specialized animal laboratory studies or autopsy findings were nonobtainable. From the second case a viral agent from the cutaneous lesions was isolated. Detailed comparative studies of the isolated virus with that of vaccinia are recorded. A review of the literature reveals a diversity of opinion as to the etiological agent in Kaposi's varicelliform eruption.