Open Journal of Pediatrics, 2011, 1, 1-3
doi:10.4236/ojped.2011.11001 Published Online March 2011 (http://www.SciRP.org/journal/OJPed/ OJPed ).
Published Online March 2011 in SciRes. http://www.scirp.org/journal/OJPed
A Life-Threatening Condition In A Child With Chicken Pox:
Eczema Herpeticum
Coskun CELTIK, Yasemin KARAL, Aslı KIBRIS, Deniz KIRCUVAL
Trakya University Faculty of Medicine, Department of Pediatrics (1), and Department of Dermatology (2), Turkey.
ABSTRACT
Eczema herpeticum is a severe infectious eruption
caused by Herpes group viruses. The disease usually
occurs in the patients with pre-existing dermatosis,
expecially atopic dermatitis. A three-year-old boy
who has high fever and widespread skin eruptions
with vesiculopustuler eruptions, erosions and ulcers
was brought out to our emergency clinic. The patient
had no pre-existing dermatosis, but he had suffered
from chicken-pox. As serological, the antibodies of
Varicella-IgM and Herpes simplex-IgM were positive.
Eczema Herpeticum which occurred on a chicken-
pox was diagnosed according to his history, physical
examination, laboratory and pathologic findings.
Acyclovir and empiric antibiotherapy together with
the symptomatic therapy were used for treatment.
His skin lesions recovered in one week after these
therapies. The aim of this case-report is to emphasize
the features of eczema herpeticum which occurred on
a pre-existing varicella eruption.
Keywords: Eczema Herpeticum; Kaposi’s Varicelliform
Eruption; Varicella; Chicken Pox; Herpes Virus; Derma-
titis; Child.
1. INTRODUCTION
Eczema herpeticum (EH) is also known as Kaposi’s
varicelliform eruption.[1] Generally, the disease occurs
as a result of the infection of Herpes simplex type-1 vi-
rus (HSV-1) on a pre-existing dermatosis.[1-3] The most
common pre-existing dermatosis is atopic dermati-
tis.[4,5]
The umblicated vesiculopustules that progress to
punched-out erosions in the setting of a widespread
dermatosis is pathognomonic for EH. The eruption oc-
curs usually on the area of the upper trunk and
head.[1-5]
Frequently, the diagnosis of EH is delayed because the
eruption is confused with the pre-existing dermatosis.
Therefore, demonstration of this disease is important.
The aim of this case report is to emphasize features of
EH.
2. CASE REPORT
A three years old boy was brought out to our clinic. His
complains were high fever, unease, eruptions with severe
puriritus and pain. In physical examination, widespread
vesiculopustuler eruption with erosion and ulcers were
determined (Figure 1). This eruption was observed
much more on the area of upper trunk and head. There
was no ocular involvement. From his history, it was un-
derstood that he had suffered from chicken-pox for a
week and his eruption had disseminated on the last three
days. His sister either had passed varicella infection
twenty days before him.
He and his family had no atopic findings and history
as a pre-existing dermatosis. However, he had suffered
from a chicken-pox infection during the previous days.
In the laboratory findings, leukocytosis (16500/mm[3];
70% lymphocytes), mild increased levels of serum
C-reactive protein (CRP) (30 mg/L) and erythrocyte
sedimentation rate (ESR) (30 mm/h) were defined. IgA,
IgM, IgG, IgE, CH50 were normal. CD4/CD8 ratio had
reversed. Natural killer (NK) activity was normal (CD16:
25.8 %, CD56: 22.5%). The antib od ies for Varicella-IgM,
HSV-1-IgM, and HSV-1-IgG were positive by specific
immunofluorescent antibody test. Moreover, Chest
X-Ray was normal. Bacterial blood cu ltures were sterile.
In Tzanck smear and Punch biopsy of the skin, charac-
teristically epidermal acantolysis with cellular balloon-
ing and intraepidermal multinuclear giant cell were ob-
served, and immunohistochemical stains were positive
for HSV.
In therapy, acyclovir (first five days: IV, secondary
five days: PO), hydroxyzine syrup, and paracetamol
syrup were used. Empiric antibiotherapy was given for
secondary infections. Locally, a mixture of oxy de zinc
pomade, dexpanthenol pomade, antibacterial pomade
and 2% eau borique solution was used for the skin le-

2 C. Celtik et al. / Open Journal of Pediatrics 1 (2011) 1-3
Figure 1. The lesions of the patient before the therapy.
Figure 2. Recovered lesions of the patient after the therapy.
sions. His symptoms recovered and his skin lesions re-
gressed in one week (Figure 2).
3. DISCUSSION
EH is an infectious eruption caused by viruses such as
HSV-1, Herpes simplex virus-2 (HSV-2), Herpes zoster
virus, Coxsackie virus, etc.[1-6] Also, EH may occur
after smallpox vaccination in a child who has atopic
dermatitis, rarely.[7] The disease is a dermatological
emergency in patient who has a pre-existing dermatosis
because these cases suffer from severe pain and puriri-
tus. Moreover, superinfections due to staphylococcus
may occur in the patients.[8] In this case, the serological
tests were positive for varicella virus and HSV-1. The
clinical, laboratory and pathological findings had sup-
ported a severe viral infection.
It has been declined that generally the patients with
EH have a pre-existing dermotosis such as atopic derma-
titis.[1-7] Moreover, Lubbe J, et al. have noticed that EH
had occurred during treatment of atopic dermatitis with
0.1% tacrolimus ointment.[9] In this case, there was no
pre-existing dermatosis except varicella eruption.
Moreover, the results of serology and Tzank smear were
positive for HSV infection, so, it was accepted that EH
had occurred due to HSV-reactivation after varicella
infection. Anamnesis, physical and histological exami-
C
opyright © 2011 SciRes. OJPed

C. Celtik et al. / Open Journal of Pediatrics 1 (2011) 1-3 3
nations are usually adequate for th e diagnosis of the dis-
turbances. Frequently, viral cultures and PCR-techniques
are not necessary for the diagnosis, because these meth-
ods are too expensive and not routine. Therefore, in this
case, viral cultures and PCR- techniques have not been
used. Physiopatology of this disease is described as a
defect in T-cell mediated immunity and reduction of NK
activity.6-10 In this case CD4/CD8 ratio had reversed, but
immune defect could not be defined.
If EH occurs due to HSV, usually it involves the face
and ocular involvement may lead to blepharoconjunctiv-
itis, keratitis and uveitis.[1,11,1 2] In this case, there was
no ocular involvement, but his face was diseased.
The therapy approach of this disease is primarily
symptomatic and supportive. As an antiviral drug; acy-
clovir should be used, corticosteroid therapy mustn’t be
applied because the disease may worsen.[1-6] In this
case, acyclovir, oxy de zinc pomade and eau borique
solution were used. In addition, empiric antibiotherapy
was us ed for the pre vention of s econd ary bacte rial infec-
tions. These therapies had been very beneficial for this
case and his lesions clearly regressed in one week.
If corticosteroid therapy is used in these patients
because of misdiagnosis, the lesions may worsen.
Therefore, if skin lesions aggravate after varicella or
another pre-existing dermatitis, EH must be consid-
ered and antiviral therapy must be started, immedi-
ately.
REFERENCES
[1] Stanberry LR. Herpes Simplex Virus. In Kliegman RM,
Behrman RE, Jenson HB, Stanton BF, eds. Nelson Text-
book of Pediatrics, 18th ed, Philadelphia; WB Saunders
Co. 2007; 1360-1365.
[2] Hill CO, Sterling JC, Kurtz JB. Viral infections. In
Champion RH, Burton JL, Burns DA, Brethnach SM, eds.
Textbook of Dermatology, 6th ed, London; Blackwell
Science Ltd., 1998: 995-1095
[3] Brook I, Frazier EH, Yeager JK. Microbiology of in-
fected eczema herpeticum. J Am Acad Dermatology
1995; 627-629
[4] Mooney MA, Janniger CK, Schwartz RA. Kaposi’s
varicelliform eruption. Cutis 1994; 53: 243-245
[5] Kristal L, Klein PA. Atopic Dermatitis in Infant and
Children. Pediatric Clinics of North America (Pediatric
Dermatology) 2000; 47:877-895
[6] Crumpacker CS: Herpes simplex. In Freedberg IM, Eisen
AZ, Wolff K, Austen KF, Goldsmith LA, Katz SI et al,
eds. Dermatology in General Medicine, 5th edition,
Newyork; Mc Graw, 1999; 2414-2426
[7] Engler RJM, Kenner J, Leung DYM. Smallpox vaccina-
tion: Risk considerations for patient with atopic dermati-
tis. J Allergy Clin Immunol 2002; 110: 357-365.
[8] Mackley CL, Adams DR, Anderson B, Miller JJ. Eczema
herpeticum: a dermatolojic emergency. Dermatol Nurs
2002; 14: 307-310
[9] Lubbe J, Pournaras CC, Saurat JH. Eczema herpeticum
during treatment of atopic dermatitis with 0.1% tac-
rolimus ointment. Dermatology 2000; 201: 249-251
[10] Goodyear HM, McLeish P, Randall S. Immunological
studies of herpes simplex virus infection in children with
atopic eczema. Br J Dermatol 1996; 134: 85-93
[11] Fivenson DP, Breneman DL, Wander AH. Kaposi’s
varicelliform eruption. Absence of ocular involvement.
Arch Dermatol 1990; 126: 1037-1039
[12] Bestue M, Cordero A. Kaposi’s varicelliform eruption in
a patient with healing peribucal dermabrasion. Dermatol
Surg 2000; 26: 939-940.
C
opyright © 2011 SciRes. OJPed