Disseminated herpes simplex virus in Adult
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Synopsis
Infection with herpes simplex virus type 1 or herpes simplex virus type 2 (HSV-1 or HSV-2) usually presents as discrete groups of painful vesicles on orolabial or genital skin. However, in some instances, HSV infection may be diffuse, involving multiple sites of the body. When multiple regions of skin and/or internal viscera are concomitantly infected, the disease is termed disseminated HSV.
Clinically, disseminated HSV presents as a widespread eruption of vesicles, pustules, and/or erosions. Constitutional symptoms often occur and commonly consist of fever and regional lymphadenopathy. Most patients recover without adverse event, but progression to fatal disease can occur. Diffuse cutaneous involvement can be associated with esophagitis, meningitis, encephalitis, and fulminant hepatitis. Multi-organ failure and death can result. Prompt diagnosis and aggressive systemic antiviral therapy are keys to avoiding morbidity and mortality.
Two general groups of patients are at risk to develop disseminated HSV: patients with underlying skin disease and immunocompromised patients (such as from immunosuppression after organ transplantation, hematologic malignancies, or human immunodeficiency virus [HIV] / AIDS). In immunocompromised hosts, orofacial or genital lesions are not requisite in active disseminated HSV. Immunocompromised patients are at risk for more frequent and more severe HSV infections, involvement of internal organs, lack of response to antiviral therapy, and longer duration of viral shedding.
Acute generalized infection of previously damaged skin with HSV is known as eczema herpeticum, or Kaposi varicelliform eruption. This clinical picture may be seen in all age groups, but it most commonly occurs in the second and third decades. Most cases are due to HSV-1, but HSV-2 is also reported. Atopic dermatitis is the most common preceding condition, but the condition may also be seen in patients with various other underlying skin conditions such as Darier disease, pemphigus foliaceus, pityriasis rubra pilaris, Hailey-Hailey disease, congenital ichthyosiform erythroderma, mycosis fungoides, patients with burns, and after use of UVA phototherapy.
Pregnant individuals with primary HSV infection are at increased risk for severe illness, ie, dissemination and hepatitis, particularly in the third trimester.
Related Topic: Herpes Simplex Virus (Overview)
Codes
ICD10CM:B00.7 – Disseminated herpesviral disease
SNOMEDCT:
13710008 – Disseminated herpes simplex
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Differentiate from zoster, which can also disseminate and present with vesicular and hyperkeratotic papules in immunocompromised patients.
- Impetigo (individual lesions may be superinfected with Staphylococcus)
- Varicella
- Vaccinia
- Erythema multiforme
- Disseminated cytomegalovirus infection
- Dermatitis herpetiformis
- Hand-foot-and-mouth disease
- Stevens-Johnson syndrome
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Management Pearls
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Therapy
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References
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Last Reviewed:01/30/2017
Last Updated:08/12/2021
Last Updated:08/12/2021
Disseminated herpes simplex virus in Adult