28-year-old male patient, diagnosed with atopic dermatitis since early childhood medicated solely with topical immunosuppressants (clobetasol propionate and pimecrolimus). Presented himself in the emergency department (ED) with a one-day history of pain and swelling of the right retromandibular area with extension to the ipsilateral ear. Cervical CT revealed right parotiditis, and the patient was discharged with analgesia. Three days later, he returned to the ED due to the emergence of right conjuntivitis and a rash, with multiple plaque-like erosive lesions dispersed throughout the face, neck and upper limbs. The cutaneous lesions were painful, some of them with signs of bacterial infection especially on the palpebrae and ear pavilions. Ophtalmoscopic examination of the right eye showed signs of keratoconjuntivitis with small branching epithelial dendrites on the surface of the cornea. The patient was admitted in the Infectious Diseases department with suspected diagnosis of eczema herpeticum with bacterial superinfection, and started treatment with intravenous acyclovir and amoxicilin-clavulanate. The diagnosis was confirmed with the molecular detection of Herpes simplex type 1 virus on a skin swab. Both ocular and cutaneous lesions progressively improved. The patient fullfield 7 days of endovenous antiviral and antibacterial, and then switched to oral acyclovir in order to complete 14 days of treatment. At discharge, the erosive lesions were all cleared, and only desquamative erythema remained (that was medicated with topic corticosteroids by Dermatology).
Funding
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Written informed consent from the patient is available.
CRediT authorship contribution statement
Elsa Alves Branco: Conceptualization, Writing – original draft, Writing – review & editing, Visualization. Lúcia Ribeiroa: Conceptualization, Writing – review & editing, Visualization. Margarida Ribeiro: Writing – review & editing, Visualization. António Martins: Writing – review & editing, Visualization. Sílvia Policarpoa: Writing – review & editing, Visualization. João Enes: Writing – review & editing, Visualization. José Miguel Lessa Silva:Writing – review & editing, Visualization. André Santos: Writing – review & editing, Visualization. António Sarmentoa: Writing – review & editing, Visualization. Filipa Cei: Conceptualization, Writing – review & editing, Visualization, Supervision. All authors have read and agreed to the published version of the manuscript.
Confict of interest
There are no conflicts of interest to declare.