acyclovir and Shock--Septic

An elderly patient presented with a 4-month history of eroded hypertrophic condylomatous plaques with areas of vesiculation on the groin and lower extremities bilaterally, associated with swelling. Biopsy and immunofluorescence studies confirmed the diagnosis of pemphigus vegetans (PVeg). Further clinical evaluation revealed deep venous thrombosis of the lower extremities and septic shock from secondarily infected pemphigus lesions. Fluid obtained from vesicles was positive for herpes simplex virus (HSV) via PCR-based testing. The patient was therapeutically anticoagulated, treated with high-dose corticosteroid therapy, broad-spectrum intravenous antibiotics and acyclovir. This case represents a constellation of diagnoses not previously described. Although pemphigus vulgaris has been linked to thromboembolic events and has been associated with HSV, these associations have not been previously reported in PVeg. The coexistence of these diseases should encourage vigilance in the clinical work up of a patient with PVeg.

Topics: Acyclovir; Adrenal Cortex Hormones; Aged; Anti-Bacterial Agents; Anticoagulants; Antiviral Agents; Groin; Herpes Simplex; Humans; Lower Extremity; Male; Pemphigus; Polymerase Chain Reaction; Shock, Septic; Simplexvirus; Venous Thrombosis

A male term neonate, at day 23 of life, presented with vesicular lesions over the trunk, which spread to allover the body on the next day. Five days later, he started developing blistering of the skin over the trunk and extremities, which subsequently ruptured, leaving erythematous, tender raw areas with peeling of the skin. The mother had vesicular eruptions, which started on the second day of delivery and progressed over the next 3 days. Subsequently, similar eruptions were noticed in two of the siblings before affecting the neonate. On the basis of the exposure history and clinical picture, a diagnosis was made of varicella infection with staphylococcal scalded skin syndrome (SSSS). The blood culture and the wound surface culture grew Staphylococcus aureus. Treatment included intravenous fluid, antibiotics, acyclovir and wound care. However, after 72 h of hospitalisation, the neonate first developed shock, refractory to fluid boluses, vasopressors and catecholamine along with other supports; and he then succumbed. In all neonates, staphylococcal infection with varicella can be fatal due to SSSS, the toxic shock syndrome or septicaemia.

Topics: Acyclovir; Adult; Anti-Bacterial Agents; Antiviral Agents; Chickenpox; Fatal Outcome; Female; Humans; Infant; Infant, Newborn; Male; Mothers; Shock, Septic; Skin; Staphylococcal Scalded Skin Syndrome; Staphylococcus aureus

Topics: Acyclovir; Antiviral Agents; Chickenpox; Chickenpox Vaccine; Child; Fasciitis, Necrotizing; Humans; Musculoskeletal Diseases; Shock, Septic; Streptococcal Infections; Streptococcus pyogenes; Vaccination