Eczema herpeticum: a potentially fatal disease.

Abstract

693The following are indications for referral to a paediatrician or paediatric neurologist, who will usually arrange computed _tomography of the brain as the first investigation.(1) Abnormal On arrival in the* casualty deparntment he was extiemely ill. He was feverish (38 5QC) and his skin was covered by a herpetiform eruption in which nearly all the vesicles had ruptured leaving a skin loss ofaround 20%.The-clinical diagnosis was eczema herpeticum. He was 100/, dehydrated with sunken eyes, reduced skin turgor, and cold extremities. Investigations showed that he had lost protein.(albumin l5g/l) and potassium (22 mmol/l). A full blood count disclosed bone marrow suppression (haemoglobin 82 g/l, white cell count 4-2x 10911 (neutrophils 20%), platelet count 81 x 109/1). Skin swabs grew Staphylococcus aureus and Streptococcus pyogenes. No viral particles were seen on electron. microscopy, but herpes simplex virus was isolated four days after culture in a human embryonic lung fibroblast and confirmed as type 1 by ditect immunofluorescence (Syva UK).He was given plasma.and intravenous solutions containing potassium (7 mnmol/kg/day) and began intravenous acyclovir and broad spectrum antibiotics. He was nursed in a heated room with paraffin niixture applied to reduce evaporation. Despite thesemeasures his temperature fell to 34°C over eight hours. He developed paralytic ileus by 14jhours after admission and the potassium concentration fell to 2-0 mmol/l. Dlespite more potassium being given he had a cardiac arrest at 16 hours; a cardiographic recording showed asystole.He was successfully resuscitated with intravenous adrenaline, potassium, and atropine and a regular heart beat was achieved by 11 minutes; during this time he had received cardiac massage and ventilation by an endotracheal tube. He was given sodium bicarbonate to counter a metabolic acidosis -(pH 7-1). Though he started breathing spontaneously two minutes. after the return of his heart beat, he was electively hyperventilated and given intravenous mannitol to reduce cerebral oedema.During the next 24hours he developed spontaneous cutaneous and gastric bleeding due to disseminated intravascular coagulation, confirmed by low platelet count, prolonged prothrombin time, reduced fibrinogen titres, and Herpes simplex virus infection of children with atopic eczema may lead to a serious and sometimes fatal condition; early diagnosis, and treatment with acyclovir may be life saving

Cathelicidin deficiency predisposes to eczema herpeticum

“…5,6 Left un-treated, ADEH may be fatal due to systemic viremia. 7 However, only a small subset of AD patients develop problems with recurrent viral infections, suggesting they may have an AMP phenotype distinct from most AD patients. Therefore this study was conducted to investigate the role of human cathelicidin in controlling HSV infection and to examine differences in cathelicidin expression between uncomplicated AD and ADEH patients.…”

A Fatal Case of Eczema Herpeticum With Septic Shock Due to Methicillin-Resistant Staphylococcus aureus

“…Most deaths are due to viremia-induced multiorgan failure, including meningitis and encephalitis. 8,9 The consequences of untreated disease highlight the importance of prompt initiation of systemic antiviral therapy for effective treatment.…”

Vesicular Eruption

“…2 Secondary impetiginization of lesions with Staphylococcus aureus or Streptococcus pyogenes may cause complications.Beforeeffectiveantiviraltreatment, the mortality rate due to eczema herpeticum was estimated between 10% and 50%, 4 with most deaths caused by viremia with multisystem organ failure, including meningitis and encephalitis. 4,5 Primary infection with HSV usually occursinchildhood.Patientswithdecreased cell-mediated immunity, as seen in atopic dermatitis, are prone to recurrent and severe HSV infections. In such patients, a strong T H 2 cell response has been suggested as a contributing factor to HSV overgrowth.…”