Eczema Herpeticum

PowerPoint Presentation: 

Swollen Eye By Jake Rigby

Case: 

Case 8 year old girl 1/52 Hx of red and swollen eye Area became increasingly inflamed, developing clusters of small blisters around they eye and forehead Area around the eye became itchy and wept clear fluid Swelling continued until eye could only open fractionally, began stinging and a slight fever was noted Taken to Walk-in-centre and told to attend a&e

Case Cont'd: 

Case Cont'd Slightly blurred vision in right eye No shooting pains across face or forehead No pain on moving eye No bleeding from sores was noted Left eye had no problems to note

History: 

History Diagnosed with eczema aged 4 Continual flare ups back of neck, abdomen and knees However she has never experienced a flare up as bad as this before Diagnosed asthma same time (aged 4) No recent exacerbations, well controlled Otherwise well

Family History: 

Family History 12 11 8 Hayfever

Social History: 

Social History Both parents smoke 20/day but outside of house Has no pets. Did own two dogs two years ago, yet they were got rid of due to the parents thinking it made her asthma and eczema worse. Parents thinks that her eczema is now better after the exit of the dogs, yet she still gets more exacerbations than they would like.

History Cont'd: 

History Cont'd Obs hx NVD 35 weeks gestation No problems noted Development = No problems to note Immunizations = Up to date

Medications: 

Medications Salbutamol Beclomethasone Betnovate Cream Doublebase cream KNDA ? Allergy Eggs and Dairy. No formal testing but father wants referral

Examination: 

Examination General Inspection = Alert, active, appears well Pulse – 88bpm Resp – 24rpm Temp – 37.8 CRT - <2 secs

Exam Cont'd: 

Exam Cont'd

PowerPoint Presentation: 

Eczematous rash around right orbit, spreading to left side of forehead and right temple Blisters were clustered and resembled typical early stage cold sores They were uniform in appearance and had begin to crust by the time of examination Orbit itself showed signs of erythema and oedema, tender and warm to touch Cervical lymph nodes were slightly swollen and tender to touch

Exam Cont'd: 

Exam Cont'd Visual acuity 6/6 Left and Right Eye PEARL No pain on eye movements, no extra ocular movements, peripheral vision deteriorated in right eye, likely due to swollen orbit. Clear discharge noted from some of the crusted lesions

PowerPoint Presentation: 

Chest = Clear Normal vesicular breathing and air entry Heart Sounds = I + II + 0 Abdomen soft non-tender Bowel Sounds = Normal

Differential Diagnosis: 

Differential Diagnosis Eczema Herpeticum Preseptal Cellulitis

Investigations/Plan: 

Investigations/Plan FBC – Assess Inflammation markers and leucocytosis which is a common finding U+E ’ s – assess for electrolyte balance due to nature of the rash A swab from one of the blisters to be taken to look for viral infection. Blood Cultures taken ( S. pneumoniae and H. Influenzae commonly found in children) Any discharge from skin breaks to be swabbed and sent to microbiology. Throat swabs and samples of nasal secretions may also help diagnosis

Eczema Herpeticum: 

Eczema Herpeticum Eczema Herpeticum is a rare but severe disseminated herpes infection that generally occurs at sites of skin damage. Atopic Dermatitis, burns, or eczema can cause this damage. It is also known as Kaposi varicelliform and usually caused by the Herpes Simplex Virus.

Signs and Symptoms: 

Signs and Symptoms Signs of eczema Herpeticum are: areas of rapidly worsening, painful eczema clustered blisters consistent with early-stage cold sores punched-out erosions (circular, depressed, ulcerated lesions) usually 1-3 mm that are uniform in appearance (these may coalesce to form larger areas of erosion with crusting) possible fever, lethargy or distress

Treatment: 

Treatment Patients with this condition are treated with intravenous and topical acyclovir. Broad spectrum antibiotics are added in serious cases or to prevent super infection. It is necessary to scrupulously care for the skin and carefully monitor fluid and electrolyte balance.

Orbital and Preseptal Cellulitis: 

Orbital and Preseptal Cellulitis

PowerPoint Presentation: 

Orbital cellulitis is an extremely serious (potentially life-threatening) but uncommon ophthalmic emergency characterized by infection of the soft tissues behind the orbital septum. Preseptal cellulitis refers to the much more common and far less serious infection anterior to the orbital septum. Very occasionally, Preseptal cellulitis progresses to orbital cellulitis; this is more likely in children.

PowerPoint Presentation: 

The most common pathogenic organisms Causing PRESEPTAL CELLULITIS are S. aureus , S. epidermidis , streptococci and anaerobes. The pathogens most commonly involved in ORBITAL CELLULITIS are the aerobic, non spore-forming bacteria - Streptococcus pneumoniae , Staphylococcus aureus , Streptococcus pyogenes and Haemophilius Influenzae (the latter classically found in children

PowerPoint Presentation: 

Orbital Cellulitis differs from Preseptal in the following ways: Proptosis is present Restriction in ocular motility occurs Pain on eye movement occurs Evidence of optic neuropathy Usually reduced visual acuity Severe pain associated with blurred vision ± diplopia

Treatment Preseptal: 

Treatment Preseptal Children: 20-40mg/kg/day oral co-amoxiclav over 24h in three divided doses. Clinical improvement should occur over 24-48 hours If this doesn't occur intravenous therapy (1-2gm iv ceftriaxone daily until response is seen) and further investigation to confirm that this is indeed a simple preseptal cellulitis and that there are no unusual organisms involved Orbital Cellulitis requires mandatory hospital admission and joint Ophthalmology and ENT care as has mortality rate of 17% and 20% of survivors become blind in affected eye.

Orbital Cellulitis: 

Orbital Cellulitis IM or more commonly IV antibiotics are used (usually ceftriaxone 1-4gm daily with 1-2gm Flucloxacillin qds) Metronidazole is used if anaerobes are suspected, this is more common in children over 10 years with chronic sinonasal disease Clindamycin plus a Quinolone used in Penicillin allergy. Optic nerve function measured every 4 hours Treatment usually lasts upto 10 days, depending on the Microorganism

Thank You For Listening: 

Thank You For Listening Questions?