The critical role of early diagnosis, multidisciplinary management, and social determinants in severe eczema herpeticum: a case study of a 24-year-old man

Summary: Abstract Body: A 24-year-old male, with a history of atopic dermatitis previously well controlled with dupilumab, presented to the emergency department with a four-week history of painful, pruritic skin vesicles and erosions, which had progressed to crusted plaques affecting his face, neck, chest, arms, and thighs. The patient was homeless, and due to financial constraints had discontinued his dupilumab and topical treatments. Three days prior to symptom onset, the patient had been cleaning rat feces beneath his place of shelter. He had been seen in the emergency department twice prior to this visit, with no definitive diagnosis made. On his third presentation, the patient was febrile with a temperature of 39.2°C, and had a leukocyte count of 14,000 cells/µL. Eczema herpeticum was suspected and he was started on empiric acyclovir 5mg/kg IV every 8 hours. A viral swab with polymerase chain reaction revealed the presence of herpes simplex virus 1, confirming the diagnosis, while a bacterial skin swab identified Pseudomonas aeruginosa and Staphylococcus aureus. Due to periocular impetiginization, ophthalmology was consulted, and mupirocin ointment was applied twice daily to the face. Symptomatic management included cool compresses, emollients, and topical corticosteroids. Within five days, the patient showed clinical improvement, was transitioned to oral valacyclovir, and connected to multidisciplinary outpatient services for continuity after discharge. This case highlights the importance of early recognition and prompt treatment of eczema herpeticum, particularly in the context of social determinants of health, such as homelessness and financial hardship, which contribute to gaps in healthcare access and exacerbate disease burden. Disclaimer: This research was supported (in whole or in part) by HCA Healthcare and/or an HCA Healthcare affiliated entity. The views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities. Benjamin Cooper¹, Taha Rasul¹, Karthik Krishnamurthy¹ 1. Dermatology, HCA FL Orange Park Hospital, Orange Park, FL, United States. Minoritized Populations and Health Disparities Research