Disseminated Herpes Simplex Virus: A Case of Eczema Herpeticum Causing Viral Encephalitis

Abstract

Eczema herpeticum is a dermatological emergency causing a mortality of up to 10% if untreated. It frequently presents in a localised form and rarely disseminates via haematogenous spread with pulmonary, hepatic, ocular and neurological manifestations. Although it commonly appears on a background of atopic dermatitis, many other dermatological conditions have been described preceding this disease. Eczema herpeticum can be easily mistaken for folliculitis and is often treated accordingly with antibacterial drugs; therefore patients will often deteriorate before a diagnosis of eczema herpeticum has been considered.

Should atopic dermatitis patients starting JAK inhibitors take prophylactic acyclovir?

“…22 Eczema herpeticum occurs in approximately 3% of patients with atopic dermatitis, and this condition has a mortality rate of up to 10% when left untreated or when it occurs in immunocompromised individuals. [23][24][25] An increased risk of herpes virus infections also occurs in patients being treated with JAK inhibitors for atopic dermatitis. 26,27 Baricitinib increases the risk of herpes zoster and herpes simplex when used in the treatment of atopic dermatitis.…”

Painful Hemorrhagic Erosions

“…[4][5][6] Herpes simplex virus encephalitis is a rare and life-threatening complication of eczema herpeticum. 7,8 We report a case of HSV encephalitis resulting from eczema herpeticum in a patient with HHD.…”

Dermatologic Emergencies CME Part II: Infections and infection-related complications

“…If not treated promptly, the mortality rate of EH can be 6%-10%, primarily due to bacterial superinfection. EH is a clinical diagnosis and can be confirmed by scraping the blister for viral culture, direct fluorescent antibody staining, PCR sequencing, or Tankz smear[90].…”