Kaposi varicelliform eruption in patients with autoimmune bullous dermatoses

• Published in: International journal of dermatology Vol. 55; no. 3; pp. e136 - e140
• Main Authors: Lehman, Julia S., el-Azhary, Rokea A.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01-03-2016
• Subjects: Adrenal Cortex Hormones - therapeutic use; Adult; Aged; Aged, 80 and over; Autoimmune Diseases - complications; Autoimmune Diseases - drug therapy; Female; Herpes simplex virus 1; Humans; Immunocompromised Host; Immunosuppressive Agents - therapeutic use; Kaposi Varicelliform Eruption - etiology; Linear IgA Bullous Dermatosis - complications; Linear IgA Bullous Dermatosis - drug therapy; Male; Middle Aged; Pemphigoid, Bullous - complications; Pemphigoid, Bullous - drug therapy; Pemphigus - complications; Pemphigus - drug therapy; Superinfection - etiology
• ISSN: 0011-9059; 1365-4632
• DOI: 10.1111/ijd.13091

Background
Viral superinfection of skin affected by preceding dermatosis has been studied extensively in eczema and reported anecdotally in pemphigus. Little is known about its involvement and complications in patients with other immunobullous diseases.
Methods
To investigate clinical features and complications of viral superinfection in patients with immunobullous diseases, we performed a retrospective chart review.
Results
We identified 12 patients with immunobullous diseases (linear immunoglobulin A bullous dermatosis, n = 2; pemphigoid, n = 3; pemphigus, n = 7) and superinfection by herpes simplex virus 1 (n = 9) or 2 (n = 3). Complications included inpatient hospitalization for intensive management of skin lesions during viral flare (n = 6), herpes keratitis (n = 1), and death due to sepsis (n = 1). Five patients previously had a skin swab negative for herpes simplex virus polymerase chain reaction before a positive test. Nine patients were taking systemic corticosteroids or corticosteroid‐sparing agents at herpetic infection; two with linear immunoglobulin A bullous dermatosis and one with a new diagnosis of pemphigus vulgaris had not.
Conclusions
Viral superinfection is a potentially serious complication in patients with immunobullous diseases. Clinicians should have a high index of suspicion for this phenomenon, even when patients are not otherwise immunosuppressed or when previous viral skin assays have been negative.