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                                         [Dermatology Reports 2011; 3:e32]                                                           [page 71]

Eczema herpeticum 
in pregnancy
Grigoriy E. Gurvits,1 Jill A. Nord2
1New York University School of Medicine,
Langone Medical Center; 2St. Vincent’s
Medical Center/ New York Medical
College, New York, NY, USA

Abstract 

Eczema herpeticum (EH), or Kaposi’s vari-
celliform 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 mis-
carriage. We describe a rare case of EH in
pregnancy, eczema herpeticum gravidarum
(EHG), which is the third published report in
the literature to date. 

Case Report

A 22-year-old gravida two para one woman
in her 23rd week of pregnancy presented with
a painful papular eruption on her face and
neck of one week’s duration. She had prior
history of AD, but has recently stopped topical
corticosteroids. She denied history of sick
contacts, sun exposure, or sexually transmit-
ted diseases. On examination, her tempera-
ture was 37.8°C, heart rate 120 beats per
minute, and blood pressure 127/72 mmHg.
There were multiple hyperpigmented plaque-
like lesions covering 80% of her body surface,
and tender umbilicated vesiculo-papular
lesions on her face, neck and upper torso in
different stages of development. Pus was
expressed from several lesions. Shotty cervical

lymphadenopathy was noted. Her fundal
height was appropriate for stated length of
pregnancy and gynecological examination was
unremarkable. Laboratory analysis showed
white blood cell count of 8.3x103/L. She tested
negative for serum rapid plasma reagin and
human immunodeficiency virus. She was
diagnosed with severe impetiginized EH with
underlying severe AD. Intravenous acyclovir 5
mg/kg per dose three times daily and intra-
venous cefazolin one gram every six hours
were administered. Local corticosteroid cream
was applied for her severe AD. On day 3, no
new lesions were noted, and herpetic rash
cleared by tenth day of therapy. Subsequently,
viral and bacterial cultures from lesions isolat-
ed HSV-1 and methicillin sensitive
Staphylococcus aureus, which was also pres-
ent in her bloodstream. She completed two
weeks of intravenous therapy and delivered
healthy baby at term.

First described by Dr. Kaposi in 1887, EH is
a disseminated herpetic infection of inflamed
skin that may complicate AD, Darier-White
disease, pemphigus foliaceus, mycosis fun-
goides, Sezary syndrome, ichthyosis vulgaris,
and burns.1 Several theories have been pro-
posed to explain pathogenesis of EH, includ-
ing decreased skin integrity, impaired plasma-
cytoid dendritic cell recruitment and local
interferon production.2 Associated findings
may include fever, malaise, lymphadenopathy,
elevated serum IgE levels, and relative lym-
phopenia.1 Failure of early recognition and
prompt treatment with intravenous acyclovir
and concomitant antibiotics may carry risk of
multiorgan failure and death.1,2 Use of corti-
costroids has not been shown to cause EH,1

and treatment of the underlying AD is war-
ranted.

To date, only two cases of EHG have been
published in English literature.3,4 Acyclovir
appears to be safe in pregnancy5 and early
therapy of EHG is indicated. Overall, EHG is
rare but serious condition that may compli-
cate pregnancy in patients with AD and
requires prompt recognition.

References

1. Wollenberg A, Zoch C, Wetzel S, et al.
Predisposing factors and clinical features
of eczema herpeticum: a retrospective
analysis of 100 cases. J Am Acad Dermatol
2003;49:198-205.

2. Wollenberg A, Wetzel S, Burgdorf WHC,
Haas J. Viral infections in atopic dermati-
tis: pathogenic aspects and clinical man-
agement. J Allegy Clin Immunol 2003;112:
667-74. 

3. Rekant SI. Eczema herpeticum and preg-
nancy. Obstet Gynecol 1973;41:387-91. 

4. Garland SM, Hill PJ. Eczema herpeticum in
pregnancy successfully treated with acy-
clovir. Aus N Z J Obstet Gynaecol 1994;34:
214-5.

5. Stone KM, Reiff-Eldridge R, White AD, et
al. Pregnancy outcomes following systemic
prenatal acyclovir exposure: Conclusions
from the international Acyclovir pregnancy
registry, 1984-1999. Birth Def Res A Clin
Mol Teratol 2004;70:201-7.

                                                                Dermatology Reports 2011; volume 3:e32

Correspondence: Grigoriy E. Gurvits, 530 First
Ave, SKI-9N, New York, NY 10016, USA.
Tel. +1.212.263.3095
E-mail: g_gurvits@hotmail.com

Key words: eczema herpeticum, pregnancy, her-
pes simplex virus, acyclovir, impetigo.

Received for publication: 11 August 2011.
Accepted for publication: 16 August 2011.

This work is licensed under a Creative Commons
Attribution NonCommercial 3.0 License (CC BY-
NC 3.0).

©Copyright G.E. Gurvits and J.A. Nord, 2011
Licensee PAGEPress, Italy
Dermatology Reports 2011; 3:e32
doi:10.4081/dr.2011.e32

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