ABSTRACT
Background: Eczema herpeticum is an infection caused by herpes simplex virus in patients with atopic dermatitis, among its complications we can find meningitis, encephalitis, acute liver failure, and Staphylococcus aureus infection. Case report: We report the case of a female patient of 5 years of age, with a history of atopic dermatitis complicated by eczema herpeticum, who was treated initially without relief. Her hospital stay was complicated with cross infections, which prolonged her course. Dermatology diagnosed eczema herpeticum. Immediately after the start of treatment, the patient showed improvement. Conclusions: Eczema herpeticum is a rare complication of atopic dermatitis, it must be suspected based on patient history and physical examination. Therefore, early recognition and diagnosis are of clinical importance. Without an appropriate approach, these patients can present shock, sepsis, and death.
Antecedentes: El eccema herpético es una infección causada por el virus del herpes simple, que afecta a pacientes con dermatitis atópica. Las principales complicaciones son meningitis, encefalitis, insuficiencia hepática aguda e infección por Staphylococcus aureus. Reporte de caso: Paciente pediátrica de 5 años, con antecedente de dermatitis atópica complicada con eccema herpético, que recibió tratamiento sin reacción satisfactoria. Durante la hospitalización tuvo infecciones nosocomiales que prolongaron su estancia. Luego de la evaluación por personal del servicio de Dermatología se estableció el diagnóstico de eccema herpético, con adecuado tratamiento, seguimiento y egreso sin complicaciones. Conclusiones: El eccema herpético es una complicación rara de la dermatitis atópica, que debe diagnosticarse con base en los antecedentes personales patológicos y la exploración física adecuada. La atención oportuna es de relevancia clínica, pues los pacientes pueden tener complicación serias (choque, sepsis, incluso la muerte). Palabras clave: Eccema herpético; dermatitis atópica; infección nosocomial; Staphylococcus aureus.
Subject(s)
Dermatitis, Atopic , Kaposi Varicelliform Eruption , Staphylococcal Infections , Female , Humans , Dermatitis, Atopic/drug therapy , Kaposi Varicelliform Eruption/complications , Kaposi Varicelliform Eruption/diagnosis , Kaposi Varicelliform Eruption/drug therapy , Child, PreschoolABSTRACT
La erupción variceliforme de Kaposi es una infección cutánea diseminada, causada en la mayor parte de los casos por el virus Herpes simple tipo 1. Se suele presentar en pacientes con alteraciones preexistentes de la barrera cutánea, especialmente en niños con dermatitis atópica. Se comunica el caso de un paciente de 84 años, quien negaba enfermedades cutáneas previas, que consultó por lesiones dolorosas y pruriginosas, en la piel del tórax y el abdomen, de 3 semanas de evolución. Con sospecha de una enfermedad infecciosa viral, bacteriana, ampollar o neutrofílica, se realizó inmunofluorescencia directa para herpes, cultivo y biopsia de piel para estudio histológico. La inmunofluorescencia fue positiva para Herpes simple tipo 1 y el estudio histopatológico mostró cambios compatibles con infección herpética y enfermedad de Darier. La enfermedad de Darier es una genodermatosis infrecuente que se suele manifestar en la adolescencia. Si bien su diagnóstico en la ancianidad es excepcional, este caso ilustra que se debe considerar en todos los pacientes que presenten erupción variceliforme. (AU)
Kaposi's varicelliform rash is a disseminated cutaneous infection, caused by Herpes virus 1. It usually presents in patients with pre-existing skin barrier disorders, especially in children with atopic dermatitis. We report the case of an 84-year-old patient, who reported having no previous skin diseases, who consulted for painful, itchy, 3-week-old skin lesions. As we suspected viral, bacterial, bullous or neutrophilic disease, direct immunofluorescence, culture, and skin biopsy for histological study were performed. Immunofluorescence was positive for Herpes simplex type 1 and the histopathological study showed changes compatible with herpetic infection and Darier's disease. Darier's disease is a rare genodermatosis that usually manifests in adolescence. Although its diagnosis in old age is anecdotal, it should be considered in patients with a varicelliform rash. (AU)
Subject(s)
Humans , Male , Aged, 80 and over , Kaposi Varicelliform Eruption/diagnosis , Darier Disease/diagnosis , Acyclovir/administration & dosage , Foscarnet/therapeutic use , Herpesvirus 1, Human/pathogenicity , Fluorescent Antibody Technique, Direct , Herpes Simplex/complications , Kaposi Varicelliform Eruption/etiology , Kaposi Varicelliform Eruption/pathology , Kaposi Varicelliform Eruption/drug therapy , Darier Disease/etiologyABSTRACT
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.
ABSTRACT
Eczema herpeticum is an extensive vesicular eruption caused by cutaneous dissemination of herpes simplex virus in patients who have underlying skin conditions or epidermal barrier disruption. Herpes simplex virus type 1 (HSV 1) is the most common etiology. This is the first report in Chile of a case of eczema herpeticum caused by HSV 2 in a patient with Darier' s disease, We review the literature and emphasize the use of sensitive and specific assays as real time polimerase chain reaction, that allow to initiate timely the correct treatment.
El eccema herpético es una erupción vesicular extensa causada por la diseminación cutánea del virus herpes simplex, en pacientes con trastornos cutáneos previos o daño de la barrera epidérmica. La etiología más frecuente es virus herpes simplex tipo 1 (VHS 1), aunque se han reportado casos de virus herpes simplex tipo 2 (VHS 2). Presentamos el primer reporte en Chile de eccema herpético por VHS 2 en un paciente con enfermedad de Darier. Realizamos una revisión de la literatura médica y destacamos la importancia del uso de técnicas sensibles y específicas como la reacción de polimerasa en cadena (RPC) en tiempo real, que posibilitan el inicio precoz de la terapéutica correcta.
Subject(s)
Humans , Male , Middle Aged , Kaposi Varicelliform Eruption/virology , Acyclovir/therapeutic use , Cloxacillin/therapeutic use , Kaposi Varicelliform Eruption/drug therapy , Polymerase Chain ReactionABSTRACT
O objetivo deste relato de caso foi apresentar uma paciente com dermatite atópica (DA) e que no primeiro ano de vida desenvolveu quadro infeccioso grave com eczema difuso em face pescoço e tórax, acompanhado de celulite periorbitária bilateral, febre alta, gemência, hipoatividade e acentuado comprometimento do estado geral. Pele xerótica com lesões vesículares, umbilicadas e com secreção purulenta. O isolamento de Staphy/occus aureus em hemocultura confirmou a suspeita de septicemia e o tratamento antimicrobiano efetivo (Ceftriaxona e Oxacilina) permitiu o seu controle e evidenciou a presença de Eczema herpeticum em face. O tratamento com Aciclovir intra-venoso e cuidados locais possibilitaram o seu controle. A infecção viral funcionou como porta de entrada para o S.aureus causando a septicemia, pouco comum em DA não complicada.
The aim of this report is to relate a one year-old female patient with atopic dermatitis (AD) that developed a severe infectious clinical picture associated with diffuse eczema in face, neck and thorax, bilateral per orbital cellulite, elevated fever, groaning, underactivity, and accentuated commitment of general condition. Pustule umbilicated vesicles over a xerotic skin were observed. Hemoculture reveals Growing of Staphy/occus aureus in hemoculture confirmed septicemia diagnose and specific antibiotic therapy (Ceftriaxona e Oxacilina) allowed its control and put in evidencethe presence of facial Herpeticum eczema. The intravenous treatment with Acyclovir associated with local care enable its control. Virus infection was the S. aureus entrance door causing septicemia, uncommon in no complicated DA patients.