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Furuya K, Takemoto Y, Kurahashi H, Hayashida H, Fujiwara S, Yamashita S, Chang Y, Tsubouchi H, Shikado K, Ogita K. Eczema herpeticum subsequent to septic shock in early pregnancy: a first case report. BMC Infect Dis 2021; 21:1247. [PMID: 34906081 PMCID: PMC8669422 DOI: 10.1186/s12879-021-06924-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 11/30/2021] [Indexed: 11/10/2022] Open
Abstract
Background Eczema herpeticum (EH) is a severe skin complication caused by human simplex virus (HSV) infection concomitant with immune dysfunction and dermatological conditions, mainly atopic dermatitis. We present the first case of EH subsequent to sepsis-related immunological suppression in pregnancy. Case presentation Septic shock developed in a 30-year-old primiparous woman at 14 weeks of pregnancy during admission for hyperemesis gravidarum. Although her life-threatening status due to sepsis improved by prompt treatment, on day 3 of treatment in the intensive care unit, blisters suddenly erupted on her face and neck and spread over her body. EH was diagnosed according to HSV type-1 antigen positivity and a past medical history of EH and atopic dermatitis. Antiviral agents were administered immediately, with positive results. Her general condition improved quickly, without central nervous system defects. This is the first report of EH following septic shock in early pregnancy. At present, we speculate that EH develops as a complication due to immunological changes in the late phase of sepsis because sepsis is mainly characterized by both an inflammatory state in the acute phase and an immunosuppressive state in the late phase. Pregnancy can also contribute to its pathogenesis, as it causes an immunosuppressive state. Mortality due to EH is relatively high; in this case, a history of EH and atopic dermatitis contributed to the initiation of prompt medical interventions for the former, with improvement in the patient’s severe condition. The combination of immunological changes in sepsis and pregnancy can cause HSV reactivation, resulting in EH recurrence. Conclusions In conclusion, if dermatological symptoms develop in a pregnant woman with a history of EH and/or atopic dermatitis treated for sepsis, EH should be suspected based not only on clinical features but also on immunological changes along with sepsis, and prompt medical interventions should be initiated.
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Affiliation(s)
- Kiichiro Furuya
- Department of Obstetrics and Gynaecology, Rinku General Medical Centre, 2-23, Rinku Ourai-Kita, Izumisano, Osaka, 598-8577, Japan. .,School of Biosciences, Sutton Bonington Campus, University of Nottingham, Sutton Bonington, Leicestershire, LE12 5RD, UK.
| | - Yuki Takemoto
- Department of Obstetrics and Gynaecology, Rinku General Medical Centre, 2-23, Rinku Ourai-Kita, Izumisano, Osaka, 598-8577, Japan
| | - Hiroki Kurahashi
- Department of Obstetrics and Gynaecology, Rinku General Medical Centre, 2-23, Rinku Ourai-Kita, Izumisano, Osaka, 598-8577, Japan
| | - Harue Hayashida
- Department of Obstetrics and Gynaecology, Rinku General Medical Centre, 2-23, Rinku Ourai-Kita, Izumisano, Osaka, 598-8577, Japan
| | - Sho Fujiwara
- Department of Obstetrics and Gynaecology, Rinku General Medical Centre, 2-23, Rinku Ourai-Kita, Izumisano, Osaka, 598-8577, Japan
| | - Saya Yamashita
- Department of Obstetrics and Gynaecology, Rinku General Medical Centre, 2-23, Rinku Ourai-Kita, Izumisano, Osaka, 598-8577, Japan
| | - Yangsil Chang
- Department of Obstetrics and Gynaecology, Rinku General Medical Centre, 2-23, Rinku Ourai-Kita, Izumisano, Osaka, 598-8577, Japan
| | - Hiroaki Tsubouchi
- Department of Obstetrics and Gynaecology, Rinku General Medical Centre, 2-23, Rinku Ourai-Kita, Izumisano, Osaka, 598-8577, Japan
| | - Kayoko Shikado
- Department of Obstetrics and Gynaecology, Rinku General Medical Centre, 2-23, Rinku Ourai-Kita, Izumisano, Osaka, 598-8577, Japan
| | - Kazuhide Ogita
- Department of Obstetrics and Gynaecology, Rinku General Medical Centre, 2-23, Rinku Ourai-Kita, Izumisano, Osaka, 598-8577, Japan
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Management of Psoriasis Herpeticum in Pregnancy: A Clinical Conundrum. Case Rep Obstet Gynecol 2016; 2016:5319425. [PMID: 27840756 PMCID: PMC5093277 DOI: 10.1155/2016/5319425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 10/03/2016] [Indexed: 11/17/2022] Open
Abstract
Introduction. Kaposi varicelliform eruption (KVE) is a widespread cutaneous viral infection, most commonly herpes simplex virus, which affects patients with underlying dermatosis. When KVE occurs in a patient with a history of psoriasis, it is referred to as psoriasis herpeticum, a rare subtype of KVE with only a handful of cases reported in the literature. To the authors' knowledge, we report for the first time a case of psoriasis herpeticum in pregnancy. Case Presentation. A 23-year-old woman in her third pregnancy presented at 26-week gestation with a 10-year history of psoriasis. Cutaneous examination revealed diffuse psoriatic plaques with scattered ~1 cm erosions. Punch biopsy of the skin revealed herpes simplex virus (HSV) infection within a psoriatic plaque, necessitating dermatological treatment. The patient experienced premature rupture of membranes at 37-week gestation. Pelvic exam showed no evidence of herpetic lesions. After labor augmentation, the patient delivered a healthy female infant with no evidence of HSV infection. Discussion. Psoriasis herpeticum is a rare and potentially devastating complication of an underlying dermatosis. With a paucity of data available to guide pregnancy-specific issues, the general management of this condition is controversial and requires a multidisciplinary care approach. Concerns for systemic infection in the mother and vertical transmission to the neonate are of critical importance.
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Gurvits GE, Nord JA. Eczema herpeticum in pregnancy. Dermatol Reports 2011; 3:e32. [PMID: 25386284 PMCID: PMC4211528 DOI: 10.4081/dr.2011.e32] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Accepted: 08/16/2011] [Indexed: 11/30/2022] Open
Abstract
Eczema herpeticum (EH), or Kaposi's varicelliform eruption, is a skin infection with herpes simplex type I virus (HSV-1) that occurs in patients with compromised skin integrity, such as atopic dermatitis (AD). Unrecognized, it may be fatal and viremia in pregnancy may lead to fetal demise and miscarriage. We describe a rare case of EH in pregnancy, eczema herpeticum gravidarum (EHG), which is the third published report in the literature to date.
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Affiliation(s)
| | - Jill A Nord
- St. Vincent's Medical Center/ New York Medical College, New York, NY, USA
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Treatment of recurrent eczema herpeticum in pregnancy with acyclovir. Infect Dis Obstet Gynecol 2010; 4:239-42. [PMID: 18476099 PMCID: PMC2364500 DOI: 10.1155/s1064744996000452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/1996] [Accepted: 07/08/1996] [Indexed: 11/22/2022] Open
Abstract
Background: Eczema herpeticum is an uncommon manifestation of an infection with herpes simplex
virus (HSV). The disease is primarily seen in patients with histories of atopic eczema. Eczema
herpeticum may be a life-threatening illness, but the mortality is felt to be <10% with modern
antiviral and antibacterial agents. The use of acyclovir for other viral infections secondary to
herpesvirus in pregnancy has been well documented. The authors now present a case report of
eczema herpeticum treated with acyclovir during pregnancy. Case: A patient with a history of eczema herpeticum presented in pregnancy with a recurrence.
She was successfully treated with intravenous (IV) acyclovir with good maternal and fetal outcome. Conclusion: Acyclovir may be utilized in pregnancy for several manifestations of HSV including
eczema herpeticum.
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