Images in Emergency Medicine

Article Outline

• Diagnosis
  • Eczema herpeticum
• Copyright

A 16-year-old boy presented with 3 days of fever and painful rash. There was a history of dermatitis without a formal diagnosis, treated with nonsteroid-based moisturizing lotions. The patient's mother had chronic eczema. Physical examination revealed a temperature of (38°7C). Heart, lung, and abdominal examination results were normal. A rash as depicted in the photographs (Figure 1, Figure 2, Figure 3) was present over the torso and extremities, sparing the face and mucous membranes. The patient was admitted to the hospital.

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• Figure 1. 

  Close up of the right chest wall.

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• Figure 2. 

  Back.

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• Figure 3. 

  Close up of the back, near right shoulder. Used with permission of David A. Guss, MD, University of California, San Diego, Department of Emergency Medicine, San Diego, CA.

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Diagnosis 

Eczema herpeticum 

A presumptive diagnosis of eczema herpeticum (Kaposi varicelliform eruption) was made at admission. The key features were the diffuse nature of the rash and the characteristic umbilicated lesions. The patient was admitted for intravenous acyclovir and vancomycin. Viral culture of a lesion grew herpes simplex 1. Direct fluorescent antibody of lesional fluid was positive for herpes simplex and negative for varicella. Eczema herpeticum is an uncommon complication of atopic dermatitis and other skin disorders because of impetiginization of abnormal and normal skin with herpes simplex. Mortality in the preacyclovir era has been reported as high as 9%.