Morning Report 5/20/2014

by Jay Khadpe MD • May 20, 2014 • Comments Off

Here’s Dr. Kendall with today’s Morning Report!

ECZEMA HERPETICUM

(Kaposi varicelliform eruption)

Distinct cutaneous eruption caused by virus on existing dermatosis

Virus (HSV-1, HSV-2, coxsackievirus A16, vaccinia virus)

Dermatosis (atopic dermatitis, seborrheic dermatitis, SLE, psoriasis, etc.)

HSV + ATOPIC DERMATITIS (main combination)

PATHOPHYSIOLOGY

Cell mediated immunity: T helper type1/T helper type 2 imbalace?

Humoral immunity: High IgE levels?

Skin barrier dysfunction

HSV is for life

EPIDEMIOLOGY

Incidence increasing (more HSV)

Mortality decreasing 50% → 10% (IV Acyclovir)

All ages

PRESENTATION

Sudden eruption, painful vesicles

Umbilicated vesiculopustules → punched out erosions

Spreads for 1 week → Resolves in 2-6 weeks

Diff dx: chickenpox, impetigo, contact dermatitis, chronic bullous disease

BADNESS

Fever, malaise, lymphadenopathy

Viremia (liver, lungs, CNS, GI, adrenal)

Secondary Infection → Septicemia

Keratoconjunctivitis

ED MANAGEMENT

Acyclovir

Abx?

Ophtho? (herpetic keratitis)

Work-up? (viral culture, DFA, Tzanck, PCR, biopsy…Derm?)

Admit severe infections and immunocompromised

The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.

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Jay Khadpe MD

Editor in Chief of "The Original Kings of County" Assistant Professor of Emergency Medicine Assistant Residency Director SUNY Downstate / Kings County Hospital