Widespread eruption in a patient with atopic dermatitis

Clinical introduction A 36-year-old woman at 12 weeks of pregnancy with a personal history of severe atopic dermatitis presented to the ED with a widespread and painful skin eruption. On physical examination, there were clusters of monomorphic blisters and crusts (see figures 1 and 2). Question Laboratory tests were within normal range. What is the most likely diagnosis?Disseminated herpes simplex virus (HSV) infection Disseminated varicella-zoster virus infection Severe atopic dermatitis flare-up Bullous impetigo Answer:A Tzanck smear showed multinucleated giant cells, and PCR confirmed an HSV type 1 infection. Staphylococcus aureus grew in skin cultures. Eczema herpeticum with secondary bacterial infection was diagnosed, and both intravenous acyclovir (5 mg/kg/8 hours) and amoxicillin/clavulanate (875/125 mg/12 hours) were administered for 1 week with full recovery. Eczema herpeticum, also known as Kaposi varicelliform eruption, is a potentially life-threatening herpetic disseminated infection mostly caused by HSV...
Source: Emergency Medicine Journal - Category: Emergency Medicine Authors: Tags: EMJ Image Challenge Source Type: research