Excluding eczema herpeticum from the differential diagnosis would be a rash decision in a patient with underlying atopic dermatitis (AD), fevers, and a progressive, diffuse monomorphic vesiculopapular eruption with erosions. Herpes simplex virus testing, which was positive for this pregnant patient, can help make the diagnosis. Clinicians should know that eczema herpeticum is a dermatologic emergency that requires prompt antiviral treatment. Although pregnancy itself is not a risk factor for eczema herpeticum, hormonal and immunologic shifts can exacerbate preexisting AD, effectively setting the stage for a severe herpetic breakout.
Comment
Excluding eczema herpeticum from the differential diagnosis would be a rash decision in a patient with underlying atopic dermatitis (AD), fevers, and a progressive, diffuse monomorphic vesiculopapular eruption with erosions. Herpes simplex virus testing, which was positive for this pregnant patient, can help make the diagnosis. Clinicians should know that eczema herpeticum is a dermatologic emergency that requires prompt antiviral treatment. Although pregnancy itself is not a risk factor for eczema herpeticum, hormonal and immunologic shifts can exacerbate preexisting AD, effectively setting the stage for a severe herpetic breakout.