Not all that vesicles is herpes

Robert R. Gruhl; Andrew Wu; Micah Niermann; Andrew Olson

doi:10.1515/dx-2017-0033

Article

Not all that vesicles is herpes

Robert R. Gruhl , Andrew Wu , Micah Niermann and Andrew Olson

Published/Copyright: November 22, 2017

Published by

Become an author with De Gruyter Brill

Submit Manuscript Author Information Explore this Subject

From the journal Diagnosis Volume 4 Issue 4

Abstract

Background:

Eczema coxsackium (EC) can manifest in patients with underlying atopic dermatitis (AD) as a diffuse vesicular rash in a febrile child. The presentation overlaps clinically with the feared diagnosis of eczema herpeticum (EH), which makes differentiating between the conditions very important.

Case presentation:

A 6-month-old girl with known AD presented with fever and rapidly spreading vesicular rash. The patient had multiple exposures including a new antibiotic prescription, introduction of new foods, 6-month vaccinations and a sick contact. She was treated empirically with acyclovir for EH until herpes simplex virus (HSV) polymerase chain reaction (PCR) returned negative and enterovirus PCR returned positive. Once the diagnosis of EC was confirmed, antiviral therapy was discontinued and she was treated successfully with supportive measures without sequelae.

Conclusions:

Differentiating EC from EH is important clinically as EC is self-limiting and resolves spontaneously whereas EH may cause severe complications if not treated early. While morphology alone cannot reliably distinguish between the conditions, clinical suspicion based on history can prompt proper testing and improve patient outcomes.

Keywords: atopic dermatitis (AD); coxsackievirus; eczema coxsackium (EC); eczema herpeticum (EH); herpes simplex virus

Author contributions: Mr. Gruhl contributed to article’s conception, data collection, writing the initial draft, making critical revisions and final approval of the article. Dr. Wu contributed to article’s conception, data collection, making critical revisions and final approval of the article. Dr. Niermann contributed to the article’s conception and final approval of the article. Dr. Olson contributed to making critical revisions and final approval of the article. All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

References

1. Nahmias AJ. Generalized eruption in a child with eczema due to coxsackievirus A16. Arch Dermatol 1968;97:147–8.10.1001/archderm.1968.01610080051008Search in Google Scholar

2. Mathes EF, Oza V, Frieden IJ, Cordoro KM, Yagi S, Howard R, et al. “Eczema coxsackium” and unusual cutaneous findings in an enterovirus outbreak. Pediatrics 2013;132:e149–57.10.1542/peds.2012-3175Search in Google Scholar PubMed PubMed Central

3. Hampton JR, Harrison MJ, Mitchell JR, Prichard JS, Seymour C. Relative contributions of history-taking, physical examination, and laboratory investigation to diagnosis and management of medical outpatients. Br Mrd J 1975;2:486–9.10.1136/bmj.2.5969.486Search in Google Scholar PubMed PubMed Central

4. Horsten H-H, Fisker N, Bygum A. Eczema coxsackium caused by coxsackievirus A6. Pediatr Dermatol 2016;33:e230–1.10.1111/pde.12874Search in Google Scholar PubMed

5. Rotbart HA, Sawyer MH, Fast S, Lewinski C, Murphy N, Keyser EF, et al. Diagnosis of enteroviral meningitis by using PCR with a colorimetric microwell detection assay. J Clin Microbiol 1994;32:2590–2.10.1128/jcm.32.10.2590-2592.1994Search in Google Scholar PubMed PubMed Central

6. Halonen P, Rocha E, Hierholzer J, Holloway B, Hyypiä T, Hurskainen P, et al. Detection of enteroviruses and rhinoviruses in clinical specimens by PCR and liquid-phase hybridization. J Clin Microbiol 1995;33:648–53.10.1128/jcm.33.3.648-653.1995Search in Google Scholar PubMed PubMed Central

7. Siegfried EC, Hebert AA. Diagnosis of atopic dermatitis: mimics, overlaps, and complications. J Clin Med 2015;4:884–917.10.3390/jcm4050884Search in Google Scholar PubMed PubMed Central

8. Ong PY, Leung DY. Bacterial and viral infections in atopic dermatitis: a comprehensive review. Clin Rev Allergy Immunol 2016;51:329–37.10.1007/s12016-016-8548-5Search in Google Scholar PubMed

9. Boguniewicz M, Leung DY. Atopic dermatitis: a disease of altered skin barrier and immune dysregulation. Immunol Rev 2011;242:233–46.10.1111/j.1600-065X.2011.01027.xSearch in Google Scholar PubMed PubMed Central

10. Chong M, Fonacier L. Treatment of eczema: corticosteroids and beyond. Clin Rev Allergy Immunol 2015;51:249–62.10.1007/s12016-015-8486-7Search in Google Scholar PubMed

Received: 2017-8-24

Accepted: 2017-10-31

Published Online: 2017-11-22

Published in Print: 2017-11-27

You are currently not able to access this content.

Articles in the same Issue

https://doi.org/10.1515/dx-2017-0033

Keywords for this article

atopic dermatitis (AD); coxsackievirus; eczema coxsackium (EC); eczema herpeticum (EH); herpes simplex virus