2025 – PAGE 159 – DERMATOLOGY

HERPES SIMPLEX VIRUS ENCEPHALITIS (HSV ENCEPHALITIS)

A question about herpes simplex virus encephalitis (HSV encephalitis) would likely mention fever, seizures, and possibly a CT finding in the temporal lobe. Treatment is STAT IV acyclovir, followed by a lumbar puncture to obtain fluid for PCR testing. An EEG might show PLEDs (periodic lateralizing epileptiform discharges).

(DOUBLE TAKE) HERPES SIMPLEX VIRUS GINGIVOSTOMATITIS

Herpes simplex virus gingivostomatitis presents with oral and perioral/vermillion border lesions/vesicles. Gingiva is friable and malodorous. There is associated lymphadenopathy. Usually caused by HSV-1. Can treat with oral acyclovir. Treat immunocompromised hosts with IV acyclovir.

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(DOUBLE TAKE) ECZEMA HERPETICUM

Eczema herpeticum is a potentially life-threatening disseminated herpes (HSV) infection occurring at sites of skin damage, including sites of eczema. Look for HSV Vesicles + Crusted Lesions. Even if a description is not given of a vesicular rash, have a high index of suspicion for a rash “not improving with steroids and/or antibiotics.” Diagnose with HSV PCR or a viral culture, but do not delay treatment. A Tzanck smear can support the diagnosis. Treat by STOPPING topical steroids and/or immunosuppressants and starting Acyclovir.

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(DOUBLE TAKE) BLUEBERRY MUFFIN RASH DIFFERENTIAL DIAGNOSIS

Blueberry muffin rash represents extramedullary hematopoiesis. Differential diagnosis for blueberry muffin rash includes TORCH infections (including syphilis), hematologic disorders (hereditary spherocytosis, hematologic disease of the newborn, twin-to-twin transfusion), vascular disorders (like multiple hemangiomas) and malignancies (neuroblastoma, congenital rhabdomyosarcoma, Langerhans cell histiocytosis, congenital leukemia cutis).

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