# Eczema Herpeticum Misdiagnosed as Facial Cellulitis in an African American Male

## TL;DR

A 19-year-old man with eczema was misdiagnosed with facial cellulitis but later found to have eczema herpeticum, highlighting the importance of accurate diagnosis.

## Contribution

The paper emphasizes the need for clinicians to consider eczema herpeticum in eczema patients presenting with skin and eye symptoms.

## Key findings

- Eczema herpeticum was misdiagnosed as facial cellulitis in a patient with active eczema.
- The patient's condition improved after antiviral treatment following a revised diagnosis.
- The case underscores the importance of considering EH in eczema patients with worsening rashes and ocular symptoms.

## Abstract

Eczema herpeticum (EH) is a cutaneous manifestation of disseminated herpes simplex virus, commonly observed in patients with active eczema. The condition often presents with systemic symptoms, including fever and fatigue, alongside vesiculopustular skin lesions. This case report describes a 19-year-old male with active eczema who was misdiagnosed with facial cellulitis in the emergency and inpatient setting in a community tertiary hospital. With worsening rash and development of ocular symptoms, the diagnosis was reconsidered to be more consistent with EH with herpetic keratitis, which improved with antiviral treatment. This report shows the significance of maintaining a high index of suspicion for EH in patients with eczema and the potential consequences of misdiagnosis and delay in treatment. It aims to enhance clinician awareness of EH and promote a broader differential for unusual presentations of common dermatological and ophthalmologic conditions, especially when caring for patients with limited access to specialist evaluation.