15. Sawhney 8, Woo P, Murray K]. Macrophage activation synd—rome: a potentially fatal complication of rheumatic disorders. Arch Dis Child. 2001; 85:421–6.
1. Stichweh D, Arce E, Pascual V. Update on pediatric systemic lupus erythematosus. Curr Opin Rheumatol. 2004; 16:577–87.
- Kaposi Varicelliform Eruption
- Outcome and follow-up
- Can lupus rash look like eczema herpeticum
- A corneal dendritic lesion with a skin eruption: eczema herpeticum, an important differential diagnosis
- Dermatitis Herpetiformis (Duhring s Disease)
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Kaposi Varicelliform Eruption
Eczema herpeticum (also known as Kaposi’s varicelliform eruption) is a rare and potentially life-threatening viral cutaneous infection. It is most commonly caused by herpes simplex virus type 1 (HSV-1), which becomes superimposed on patients whose skin barrier has been disrupted (typically by pre-existing atopic dermatitis). 1 The condition presents as clusters of punctated vesicopustules with associated cutaneous pain. Once HSV has broken the skin barrier, it can rapidly disseminate and potentially involve multiple organs. 2
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Outcome and follow-up
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To date, the pathophysiology of Kaposi varicelliform eruption (KVE) remains unclear. A number of preexisting conditions have been associated with KVE, including atopic dermatitis (AD), pemphigus, Darier disease, seborrheic dermatitis, lupus erythematosus, psoriasis, Wiskott-Aldrich syndrome, congenital ichthyosiform erythroderma, mycosis fungoides, and Sézary syndrome. [2, 3, 4]
Can lupus rash look like eczema herpeticum
The key symptoms of DH typically include the following:
16. Isome M, Suzuki 1, Takahashi A, Murai H, Nozawa R, Suzuki S, et al. Epstein-Barr Virus—associated hemophagocytic syndrome in a patient with lupus nephritis. Pediatr Nephrol. 2005; 20:226–8.
Macrophage activation syndrome (MAS) is a rare complication in systemic lupus erythematosus (SLE) that can be triggered by infections. Due to the fact that MAS may mimic clinical features of underlying rheumatic disease, or be confused with an infectious complication, its detection can prove challenging. This is particularly true when there is an unknown/undiagnosed disease; and could turn into an even greater challenge if MAS and SLE are combined with a viral infection. A—i4-year—old female came to the hospital with an ongoing fever for 2 weeks and a painful facial skin rash. Hepatomegaly, pancytopenia, increased aspartate aminotransferase, elevated serum ferritin and lactate dehydrogenase were reported. No hemophagocytic infiltration of bone marrow was reported. The patient was suspected for hemophagocytic lymphohistiocytosis. Her skin rashes were eczema herpeticum, which is usually associated with immune compromised conditions. With the history of oral ulcers and malar rash, positive ANA and low C3, C4 and the evidence of hemolytic anemia, she was diagnosed as SLE. According to the diagnostic guideline for MAS in SLE, she was diagnosed MAS as well, activated by acute HSV infection. After administering steroids and antiviral agent, the fever and skin rash disappeared, and the abnormal laboratory findings normalized. Therefore, we are reporting a rare case of MAS triggered by acute HSV infection as the first manifestation of SLE.
A corneal dendritic lesion with a skin eruption: eczema herpeticum, an important differential diagnosis
Consultation with an ophthalmologist is indicated when eye involvement is suspected. Herpetic keratitis can lead to scarring. Fortunately, ocular herpetic infection in the setting of KVE is rare.
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A 54-year-old man with a background of eczema and asthma presented to the emergency eye clinic with a 2-day history of worsening pain, photophobia and discharge from his left eye. Examination revealed a visual acuity of 6/36 in his left eye (baseline 6/12) and a 3×3 mm dendritic infiltrate on the cornea. An initial diagnosis of herpes simplex keratitis was made, although the presence of mild pruritus and erythema in the distribution of the ophthalmic division of the trigeminal nerve (V1), led to suspicion of herpes zoster ophthalmicus. The patient was given a course of oral aciclovir 800 mg five times a day, guttae aciclovir 3% five times a day, and guttae ciprofloxacin 0.3% four times a day, with a plan to review after 3 days.
If you cannot tolerate dapsone, we will give you another medication instead, but keep in mind that these are less effective. You may need to continue this medication regime for up to two years to help prevent future dermatitis herpetiformis outbreaks until the gluten-free diet takes effect.
Dermatitis Herpetiformis (Duhring s Disease)
Proposed mechanisms to account for the increased susceptibility of individuals with AD to develop KVE or eczema herpeticum (EH) include systemic immune defects involving both cell-mediated and humoral immunity, as well as impairment in cutaneous immune responses that are interrelated with the defective mechanical barrier properties of affected skin in person with AD.
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At follow-up with a different clinician it was noted that while the corneal dendritic ulcer had largely resolved with visual acuity improving to 6/12, the facial rash had developed into an erythematous vesicopustular rash with cutaneous dendrites ( figure 1 ), which had spread across the midline and did not respect the boundaries of the V1 dermatome ( figure 2 ). Upper and lower lids on the left side were swollen, although there was a full range of extraocular movements with no proptosis and no relative afferent pupillary defect. A diagnosis of eczema herpeticum was suspected, and a detailed history revealed the patient had a current exacerbation of his eczema.
People with dermatitis herpetiformis may rarely go into remission. This means that you have not showed any skin lesions or DH symptoms for more than two years while not taking medication or following a gluten-free diet.