Disseminated herpes simplex virus in Child
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Synopsis
Herpes simplex virus (HSV) can occur on any body surface. When the infection is not localized, it is referred to as disseminated HSV infection. In transplant patients on immunosuppressive medications, immunosuppressed cancer patients, patients immunosuppressed from heritable or acquired immunodeficiency disorders, and in patients with underlying skin diseases (atopic dermatitis in particular), HSV can disseminate and cause severe morbidity and mortality.
Clinically, disseminated HSV presents as a widespread eruption of vesicles, pustules, and/or erosions. Constitutional symptoms often occur and commonly consist of fever and regional lymphadenopathy. Most patients recover without adverse event, but progression to fatal disease can occur. Diffuse cutaneous involvement can be associated with esophagitis, meningitis, encephalitis, and fulminant hepatitis, especially in immunocompromised hosts. Multi-organ failure and death can result. Prompt diagnosis and aggressive systemic antiviral therapy are keys to avoiding morbidity and mortality.
Acute generalized infection of previously damaged skin with HSV is known as eczema herpeticum, or Kaposi varicelliform eruption. This clinical picture may be seen in all age groups, but it most commonly occurs in the second and third decades. Most cases are due to HSV-1, but HSV-2 is also reported. In those with skin disease, young patients with atopic dermatitis are the most frequently affected, but individuals with various skin disorders, such as Darier disease (keratosis follicularis), pemphigus foliaceus, pityriasis rubra pilaris, Hailey-Hailey disease, congenital ichthyosiform erythroderma, mycosis fungoides, Sézary syndrome, and patients with burns, have also developed this condition.
Related topic: Herpes Simplex Virus (Overview)
Codes
ICD10CM:B00.7 – Disseminated herpesviral disease
SNOMEDCT:
13710008 – Disseminated herpes simplex
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Differentiate from zoster, which can also disseminate and present with vesicular and hyperkeratotic papules in immunocompromised patients.
- Impetigo (individual lesions may be super-infected with Staphylococcus)
- Varicella
- Vaccinia
- Erythema multiforme
- Disseminated cytomegalovirus infection
- Hand-foot-and-mouth disease
- Stevens-Johnson syndrome
- Bullous dermatosis of childhood
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Management Pearls
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Therapy
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References
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Last Reviewed:01/30/2017
Last Updated:01/26/2017
Last Updated:01/26/2017
Disseminated herpes simplex virus in Child