Disseminated life-threatening viral skin rash in a child with AD

A 14-month-old toddler presented with weakness, fever, restlessness, and reduced appetite. His symptoms had appeared along with a skin rash, 2 weeks after a measles-mumps-rubella (MMR) vaccination. The parents also reported that the boy had played with other kids outdoors in the sun and sand on a hot weekend 3 days before the vaccination episode. During early infancy, the child had been diagnosed with mild atopic dermatitis (AD). 

On examination, he had a disseminated vesico-pustular rash. Additionally, the boy had generalized malaise, temperature - 37.1°C; heart rate - 118 bpm; respiratory rate - 31 breaths/min; and cervical lymphoadenomegalia. The skin lesions were diffuse, grouped, monomorphic outcomes of vesicles that oozed and eroded, transforming into coalescing sero-hematic crusts at the erythematous base. The lesions were widespread and had exacerbated on the sites of scratching and those that incurred friction on crawling. The characteristics signified atopic eczema.

The child’s C-reactive protein was 0.78 mg/dL, and the large uncolored cells were elevated (5.5%). The diagnosis was eczema herpeticum (EH); the serological examinations (positive immunoglobulin (Ig)G and IgM) exhibited a secondary herpes simplex virus type 1 (HSV-1) infection. 

The HSV-1 manifestation likely occurred due to an altered immune response to the MMR vaccine with the AD background, thus precipitating EH. Therefore, pediatric patients with AD must be carefully monitored post vaccinations. AD is not a contraindication for vaccination. This paper underscored the need for prompt diagnosis and treatment of complications in children with AD to prevent vaccination-related complications.

Source: Herzum A, Occella C, Garibeh E, et al. Clinical and Experimental Vaccine Research. 2023 Apr;12(2):176.