Syringitis: a clue to herpes infection

Area of Science:

• Dermatopathology
• Virology
• Pediatric Pathology

Background:

• Herpes simplex virus (HSV) commonly causes skin infections with characteristic epidermal histopathologic findings.
• Involvement of adnexal structures like hair follicles and sebaceous glands is uncommon.
• Eccrine gland involvement by HSV is exceptionally rare in clinical presentations.

Observation:

• A 13-month-old child with extensive burn injuries presented with atypical skin lesions.
• Histopathologic examination revealed syringitis (inflammation of the eccrine sweat gland duct) with distinct herpetic features.
• These herpetic features were observed in the absence of typical epidermal changes.

Findings:

• The diagnosis of herpes simplex virus infection was established based on herpetic syringitis.
• This finding was crucial for diagnosis, particularly given the absence of epidermal lesions.
• The case demonstrates an unusual presentation of HSV affecting eccrine glands in a pediatric burn patient.

Implications:

• This case expands the understanding of HSV histopathologic manifestations beyond the epidermis.
• It underscores the importance of considering adnexal structures, including eccrine glands, in the differential diagnosis of skin infections.
• Recognizing herpetic syringitis can aid in diagnosing HSV in challenging clinical scenarios, such as in burn patients where epidermal changes may be obscured.