Eczema Herpeticum: A Fatal Rash That Mimics Many

Eczema herpeticum (EH) is a potentially life-threatening condition, especially in the pediatric population, that occurs among patients with atopic dermatitis (AD). AD is a chronic inflammatory skin disorder with a complex pathophysiology that predisposes patients to EH. Herpes simplex virus (HSV) 1 is implicated in 90 % of EH cases and often initially presents with gingivostomatitis. HSV 1 can also lead to more systemic disease such as keratoconjunctivitis, meningitis, encephalitis, and hepatitis. Rapid diagnosis of EH is vital, and prompt treatment is essential to preclude these complications. We describe a 5-month-old male with poorly controlled atopic dermatitis who presented with generalized polymorphic rash diagnosed with EH and superimposed MSSA cellulitis. This clinical scenario, while not uncommon, is often missed and underlies the importance of a strong clinical suspicion for EH among patients with AD presenting with complicated rash. EH is an infectious complication that is easily misdiagnosed causing treatment delays that lead to dire consequences. This report also includes an abridged review of literature on EH.