Erupción variceliforme de Kaposi en un paciente adulto mayor con desnutrición severa

El eccema herpético o erupción variceliforme de Kaposi, a pesar de ser una infección viral poco frecuente, se considera una urgencia dermatológica, debido a su alto potencial de diseminación, gravedad y mortalidad en adultos. Los pacientes inmunosuprimidos suponen un alto riesgo de colonización cutánea y visceral, además de una mayor probabilidad de presentar otras infecciones causadas por el virus del herpes simple. Se caracteriza por presentar lesiones en piel de tipo vesículas umbilicadas agrupadas o diseminadas que evolucionan a erosiones hemorrágicas perforadas, que se localizan principalmente en cabeza, cuello y tórax; son dolorosas y tardan entre 2-6 semanas en sanar y por lo general se asocian a compromiso sistémico. El diagnóstico es clínico; en caso de duda, se puede utilizar Test de Tzanck, que es una herramienta rápida para confirmar infección por herpes virus; tiene una sensibilidad de 40-80 % y especificidad hasta del 100 %. El manejo consiste en terapia antiviral sistémica; el tratamiento antibiótico está indicado si existe riesgo sobreinfección bacteriana. El tratamiento oportuno de la infección es clave para la evolución hacia la recuperación del paciente.

Eczema herpeticum or Kaposi's varicelliform eruption is a rare viral infection; however, it's considered a dermatologic urgency due to the high potential for dissemination, severity and mortality. Immunosuppressed patients have a high risk of skin and visceral colonization in addition to a higher probability of other infections caused by herpes simplex virus. Kaposi's varicelliform eruption is characterized by vesicopustules, some umbilicated, others eroded and extended in clusters. They may also present hemorrhagic crusts with an erythematous base. The most commonly affected sites are head, neck, and trunk. These lesions are painful, they take from 2 to 6 weeks to heal and are usually associated with systemic signs of infection. Diagnosis is mainly clinical. In case of doubt, the Tzanck allows a rapid diagnostic approach with a sensitivity of 40-80 % and specificity up to 100 % in herpes virus. Antiviral treatment proved to be effective; additional antibiotic treatment is required if there is risk of bacterial infection. The timely treatment of the infection is the key in the evolution towards the recovery of the patient.

Recurrent Kaposi Varicelliform Eruption: Investigation of Clinical Characteristics and Predisposing Factors / 대한피부과학회지

BACKGROUND: Kaposi varicelliform eruption (KVE) is a disseminated viral infection primarily caused by the herpes simplex virus in the setting of an underlying chronic skin disease. Few studies have reported the clinical characteristics and predisposing factors for recurrent KVE.OBJECTIVES: To characterize the clinical features and predisposing factors for recurrent KVE.METHODS: This retrospective comparative study of recurrent vs. single-episode KVE was performed at the Pusan National University Hospital between 2004 and 2017.RESULTS: A total of 84 episodes occurred in 60 patients, and of these, 13 patients developed recurrence (21.7%). No statistically significant intergroup difference was observed in the mean age and sex distribution. The face was the most common site of involvement in both groups, followed by the trunk and the upper and lower extremities. Atopic dermatitis was the most common pre-existing disease in both groups; however, Darier's disease was more common in the recurrent KVE group, and this difference was statistically significant. Most patients with KVE (66.7%) showed aggravation of the underlying skin disease within 3 months of KVE onset. This finding was more prominent in patients with recurrent episodes (91.7%) than in those with single-episode KVE (58.3%), (p=0.040).CONCLUSION: This study can contribute to a better understanding of recurrent KVE and guide clinicians in treating patients with conditions predisposing to KVE.

Kaposi varicelliform eruption with severe complications:a case report / 临床儿科杂志

Objective To investigate the clinical features and prognosis of Kaposi varicelliform eruption with severe complications. Methods The clinical data of one child with Kaposi varicelliform eruption with severe complications was retrospectively analyzed. The related literatures were reviewed. Results A 5-month-old boy presented with recurrent rash on the head and face for 3 months and aggravated for 3 days. The skin lesions showed a characteristic of typical dome-shaped blisters with hemorrhagic crusting. At admission, the boy suffered with severe hypoproteinemia, hypocalcemia, and electrolyte disorder. The hypocalcemia was aggravated gradually. On the fifth day of admission, the boy had fever, convulsions, and tachycardia. Blood culture showed methicillin-resistant Staphylococcus aureus (MASA) infection. The diagnosis of sepsis was confirmed. At that very day, the boy started to have coagulopathy, so Fusidic and Vancomycin for anti-infection, Acyclovir for antivirus, intravenous infusion immunoglobulin, albumin, cryoprecipitate, plasma and calcium gluconate were administered, supplied with albumin and blood coagulation factor. The boy's condition gradually became stable and discharged on the 19th day after admission. Conclusions When Kaposi varicelliform eruption is complicated with hypoproteinemia and hypocalcemia, the critical illness is indicated. Clinicians should be alerted to the existence of sepsis, coagulation disorders, even septic shock and disseminated intravascular coagulation.

Kaposi's Varicelliform Eruption due to Varicella Zoster Virus in a Patient with Atopic Dermatitis / 대한피부과학회지

No abstract available.

A Case of Endothelial Keratitis Associated with Immunosuppressant in Kaposi's Varicelliform Eruption

PURPOSE: To report a case of endothelial keratitis occurred after reactivation of herpes simplex virus following immunosuppressant therapy for Kaposi's varicelliform eruption. CASE SUMMARY: A 23-year-old female was referred for ocular pain and blurred vision. She had atopic dermatitis and was diagnosed with Kaposi's varicelliform eruption on her face after using an immunosuppressant. Slit lamp examination revealed central corneal edema in the right eye. She was initially diagnosed with contact lens-induced keratitis. Subsequently, the contact lens was removed and topical antiviral agent used for prevention of ocular involvement. Four days after treatment, Wesseley immune ring of deep stromal haze and cells in the anterior chamber were present. She was diagnosed with endothelial keratitis caused by reactivation of herpes simplex virus after using an immunosuppressant. Topical steroid, hypertonic saline eye drops and cycloplegic eye drops were added to the treatment for the progression of endothelial keratitis. Corneal edema was decreased 2 weeks after treatment and anterior chamber cells decreased 1 month after treatment. There was no recurrence during the follow-up period. CONCLUSIONS: Patients diagnosed with Kaposi's varicelliform eruption after using immunosuppressants should have an ophthalmic examination to confirm ocular involvement; use of appropriate eye drops is necessary for the treatment of corneal involvement.

Eccema herpético por virus herpes simplex tipo 2: revisión de la literatura a propósito de un caso / Eczema herpeticum caused by herpes simplex virus type 2: review of the literature about one case

Eczema herpeticum is an extensive vesicular eruption caused by cutaneous dissemination of herpes simplex virus in patients who have underlying skin conditions or epidermal barrier disruption. Herpes simplex virus type 1 (HSV 1) is the most common etiology. This is the first report in Chile of a case of eczema herpeticum caused by HSV 2 in a patient with Darier' s disease, We review the literature and emphasize the use of sensitive and specific assays as real time polimerase chain reaction, that allow to initiate timely the correct treatment.

El eccema herpético es una erupción vesicular extensa causada por la diseminación cutánea del virus herpes simplex, en pacientes con trastornos cutáneos previos o daño de la barrera epidérmica. La etiología más frecuente es virus herpes simplex tipo 1 (VHS 1), aunque se han reportado casos de virus herpes simplex tipo 2 (VHS 2). Presentamos el primer reporte en Chile de eccema herpético por VHS 2 en un paciente con enfermedad de Darier. Realizamos una revisión de la literatura médica y destacamos la importancia del uso de técnicas sensibles y específicas como la reacción de polimerasa en cadena (RPC) en tiempo real, que posibilitan el inicio precoz de la terapéutica correcta.

Kaposi's Varicelliform Eruption Complicating Lichen Simplex Chronicus

Kaposi's varicelliform eruption results from a widespread infection of a virus to skin damaged by predisposing dermatoses. It is usually a manifestation of a primary herpes simplex virus type 1 (HSV-1) infection in a child with atopic dermatitis, but other skin conditions can be complicated. Here, we report an unusual case of KVE arising from lichen simplex chronicus on the male genital area.

A Clinicopathological Study of Kaposi's Varicelliform Eruption / 대한피부과학회지

BACKGROUND: Kaposi's varicelliform eruption (KVE) is a viral infection with disseminated skin involvement, superimposed on a pre-existing dermatosis. A monomorphic eruption of dome-shaped blisters and pustules in the eczematous lesions, along with severe systemic illness, leads to clinical diagnosis. However, there is no data on the clinicopathologic study of KVE in Koreans. OBJECTIVE: The purpose of this study was to identify clinicopathologic features of KVE. METHOD: We reviewed the medical records and biopsy slides of 21 patients who had previously been diagnosed as having KVE at the National Medical Center between 1990 and 2004. RESULTS: The study results are summarized as follows: 1. The most common pre-existing disease was atopic dermatitis, followed by seborrheic dermatitis and Darier's disease. 2.Men were more commonly affected than women, and the mean age at diagnosis of eczema herpeticum was 30.8 years. 3.Face involvement was seen in 4 patients, and systemic involvement in 6 patients. 4. Histopathologically, common findings included ballooning degeneration (76.1%), reticular degeneration (47.6%), multinucleated giant cell (57.1%), and inclusion body (28.6%), and leukocytoclastic vasculitis (47.6%). CONCLUSION: KVE is a secondary viral infection that can affect patients who suffer from a primary dermatologic condition. In many instances, the history and clinical findings may be sufficient for diagnosis of KVE. However, the clinicopathologic features can help also diagnose KVE and pre-existing dermatosis.