BIOLOGY 2D03 Study Guide - Fall 2018, Comprehensive Midterm Notes - Mountain Time Zone, Syndrome, Personal Computer
12 Oct 2018
School
Department
Course
Professor
BIOLOGY 2D03
MIDTERM EXAM
STUDY GUIDE
Fall 2018
Eczema Herpeticum
History
George is a 2-year-old boy who presents to the paediatric rapid referral clinic
PC
Worsening of his eczema
HPC
The latter was diagnosed by the GP when he was 6 months old.
He has been treated with a variety of emollients and topical steroids which are
applied on an intermittent, as-required basis.
The parents report that over the last 3 days the eczema has gradually
deteriorated and also become more itchy.
System Review
General – Generally fit and well
Neuro- Nil
Cardio – Nil
Resp- Nil
Gastro – Nil
Uro – Still same number of wet nappies
Musc – Nil
Derm – Nil
PMH + PSH
Birth – SVD 38+4, no complications
Feeding – Normal diet
Previous admissions- Nil
Conditions –Asthma
Medications and Allergies- inhaled budesonide twice a day and inhaled
salbutamol on an as-required basis and NKDA
Vaccinations- Up to date
Developmental
No concerns about development
FMH
His mother had eczema as a child but grew out of it and his father has hay fever.
SH
Only child
No social worker
Extra questions
Previous episodes?
Anyone in the family
have cold sores?
Examination
Basic obs:
Temperature is 38.3 °
C, RR: 20, HR: 100, BP
110/80 and O2 sats
RA 98%
General observation:
George is well
hydrated but itchy and
miserable.
Height and weight:
JWH, JM, AJS
80
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Normal
Derm:
He has widespread eczema all over his body, which is worst on his face, hands
and arms where the skin feels moist.
A number of vesicles and some punched-out lesions can be seen on the face,
hands and arms.
There are also pustules and some areas of honey-coloured crusting in those
areas.
In some areas the lesions have coalesced.
The marked scratching that has taken place makes the exact nature of the
lesions more difficult to determine.
His eyes are puffy and there are some surrounding lesions.
The eyes themselves appear normal but are difficult to assess fully. There is
cervical, axillary and inguinal lymphadenopathy.
Other examinations:
His chest is clear.
Differential Diagnosis
Eczema herpeticum
Bacterially infected eczema
Impetigo
Poorly controlled eczema
Eczema herpeticum + super added bacterial infection
Eczema herpeticum is caused by herpes simplex virus infection of eczematous
skin. It is most often a complication of atopic dermatitis. While its severity can
vary, eczema herpeticum in young infants is a medical emergency. Early
diagnosis and treatment may be life saving. The infection spreads along the skin
and haematogenously.
Eczema herpeticum typically presents in areas of active or recently healed atopic
dermatitis. Vesicles and pustules occur and these may coalesce, erode the skin
and become haemorrhagic and crusted. The lesions can disseminate rapidly and
may cause life-threatening infection. Eczema herpeticum may also affect the
conjunctiva and cornea and can cause a keratitis that, if left untreated, may lead
to blindness.
Patients with atopic dermatitis often have secondary impetigo with S aureus.
Eczema herpeticum with bacterial superinfection can have a slower resolution,
progress to sepsis, or even lead to death. Therefore, bacterial culture with
antibiotic sensitivities should be performed, and appropriate systemic
antibiotics prescribed.
Investigations
FBC
U&E
LFT
ESR and CRP
Blood culture
Skin swabs taken for bacteriology and virology
o Microscopy: Giemsa-stained Tzanck smears of cells scraped from a vesicle
base (showing multinucleated giant cells)
JWH, JM, AJS
81
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Document Summary
George is a 2-year-old boy who presents to the paediatric rapid referral clinic. The latter was diagnosed by the gp when he was 6 months old. He has been treated with a variety of emollients and topical steroids which are applied on an intermittent, as-required basis. The parents report that over the last 3 days the eczema has gradually. Resp- nil deteriorated and also become more itchy. Uro still same number of wet nappies. Medications and allergies- inhaled budesonide twice a day and inhaled salbutamol on an as-required basis and nkda. His mother had eczema as a child but grew out of it and his father has hay fever. George is well hydrated but itchy and miserable. He has widespread eczema all over his body, which is worst on his face, hands and arms where the skin feels moist. A number of vesicles and some punched-out lesions can be seen on the face, hands and arms.
