Eczema Herpeticum Complicating Atopic Dermatitis: A Rare Presentation

TL;DR

A rare case of eczema herpeticum in an infant with atopic dermatitis is reported, highlighting the importance of timely diagnosis and treatment.

Contribution

This case report adds to the limited literature on eczema herpeticum in infants with atopic dermatitis.

Findings

The infant presented with worsening skin lesions consistent with eczema herpeticum.

Intravenous acyclovir treatment led to resolution of skin lesions after six weeks.

Eczema herpeticum is rare but a serious complication of atopic dermatitis.

Abstract

Atopic dermatitis (AD) has become a global health concern due to an increase in its frequency over the past few decades. This illness not only reduces the quality of life but also imposes a considerable financial burden due to the increased risk of skin infections.

This case report explores the presentation of a four-month-old male infant with a personal history of atopic dermatitis that developed yellow scaly lesions on the scalp, which were assumed to be cradle cap. However, there was a clinical worsening of the cutaneous lesions, with the appearance of vesicles, so he was referred to the Pediatric Emergency Room after an urgent dermatology appointment. A blood test was performed, which revealed severe eosinophilia and a slightly increased total IgE. Considering the patient's past medical record of atopic dermatitis and the observable characteristics of the skin rash, there was a strong suspicion of eczema herpeticum (EH). Consequently, intravenous acyclovir treatment was initiated, along with an antibiotic, as there were concerns about a potential secondary infection. He was followed up with a pediatric and dermatology appointment, with a resolution of skin lesions after six weeks.

EH is a rare clinical entity, usually caused by herpes simplex virus (HSV) types 1 and 2. It is a clinical entity that, while being uncommon, is one of the few dermatological emergencies responsible for a high morbidity rate, associated with the systemic spread of the viral infection.

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