Year: 2019 I Volume: 2 I Issue: 2 I Page: 51-52

Significance of a simple bedside test in the early diagnosis of a rare case of Kaposi’s varicelliform eruption

Department of Dermatology, Command Hospital Air Force, Bangalore

Corresponding Author:
Dr. Eeshaan Ranjan
Email: : eeshaan.ranjan@gmail.com

How to cite this article:
Dabas R, Ranjan E, Arora S, Donaparthi N, Rout A. Significance of a simple bedside test in the early diagnosis of a rare case of Kaposi’s varicelliform eruption. JDA Indian Journal of Clinical Dermatology. 2019;2: 51-52


Kaposi’s varicelliform eruption (KVE) is a disseminated Herpes simplex virus (HSV) infection which is superimposed on a preexisting dermatosis. Hailey-Hailey disease (HHD) is a rare genetic dermatosis which is characterized by chronic, recurrent vesicles, erosions and fissures in flexural areas. It is an autosomal dominant condition due to mutations in ATP2C1 gene, leading to defects in keratinocyte adhesion and intraepidermal 1,2 acantholysis. The occurrence of KVE along with HHD is very uncommon. We hereby report a case of Hailey-Hailey disease who developed KVE and an early diagnosis was arrived at with a simple bedside test, i.e. Tzanck smear.

A 49-year-old male, a known case of HHD, with seasonal recurrences and remissions since 9 years was referred to our hospital with an acute exacerbation of lesions in the form of macerated lesions with oozing and crusting involving neck, both armpits and groins and multiple red raised lesions over the chest and back of one month duration. On examination, he had macerated and crusted plaques on the neck, both axilla and genitocruralfolds andmultiple erythematousmacules and papules over the chest and back. (Figure 1, Figure 2). 10% potassium hydroxide (KOH) mount ofskin scraping from axilla was positive for Candida. In view of the widespread involvement, he was started on oral corticosteroids and antihistamines along with oral and topical antifungal agents for the axilla and groins. However, while on therapy, after about a month, he developed fever and sudden eruption ofmultiple red raised andfluidfilled lesions on the body. On examination, he was febrile and had multiple, discrete vesicles over on an erythematous base with central umbilication and multiple pustules distributed primarily on the chest, abdomen and back (Figure 3) along with increase in oozing and crusting of pre-existing lesions over the flexures (Figure 4). Tzanck smear showed multinucleated giant cells (Figure 5). His total leukocyte count was raised along with increase in the neutrophils but other hematological and biochemical parameters were within normal limits. Serology for IgM and IgG antibodies to HSV was positive. Polymerase chain reaction (PCR) for HSV was also positive. Skin biopsy from one of the lesions showed intraepidermal acantholytic keratinocyte separation with perivascular lymphocytic infiltrate in the dermis. (Figure 6). Based on the clinical features and Tzanck smear he was diagnosed as a case of KVE which was confirmed later with serology and PCR for HSV infection. He was managed with intravenous Acyclovir initially for four days followed by oral Acyclovir along with Injection Amoxycillin with Clavulanic acid and nursing care. Systemic corticosteroids were continued and gradually tapered and stopped. After ten days of treatment, there was complete resolution of the herpetic lesions and other lesions also started improving.

KVE is a serious life-threatening HSV infection that arises in preexisting skin disorders. In some cases, it may progress to a lifethreatening condition in the form of disseminated infection with visceral involvement and death. The most common predisposing factoristhe breach in the stratumcorneumsecondary to skin disease.

Figure 1: Macerated and crusted plaques involving axilla

Click here to view

Figure 2: Macerated and crusted plaques involving genitocrural folds

Click here to view

Figure 3: Discrete vesicles over on an erythematous base with central umbilication and multiple pustules

Click here to view

Figure 4: Discrete vesicles over on an erythematous base with central umbilication and multiple pustules

Click here to view

Figure 5: Tzanck smear (1000 X ) showing multinucleated giant cell

Click here to view

Figure 6: Histopathology (H & E 100X) showing intraepidermal acantholytic keratinocyte separation with perivascular lymphocytic infiltrate in dermis.

Click here to view

It has been reported to occur in various pre-existing dermatoses namely, Darier’s disease, mycosis fungoides, Sézary syndrome, atopic dermatitis, seborrheic dermatitis, pemphigus foliaceus, ichthyosis vulgaris, and Hailey-Hailey disease.1 It begins as clusters of umbilicated vesicles and pustules in the areas where the skin has been affected by a pre-existing dermatosis. Tzanck smear from scraping of vesicle base showingmultinucleated giant cellssupports the diagnosis. Importance to this bed side test cannot be stressed enoughasinourcaseithelpedusforanimmediatebedsidediagnosis whenhewas examinedforthis eruption.Diagnosis canbe confirmed by polymerase chain reaction for viral DNA, electron microscopic detection of herpes virus from blister fluid or immunofluorescence testsforcellsaffected by HSV.3

Treatment with intravenous acyclovir should be started without delay in case of high suspicion of KVE or a positive Tzanck smear as was done in our case. The other antiviral drugs which can be used are valacyclovir and famciclovir.

The occurrence of KVE with HHD has rarely been reported. We came across a few such cases in literature.4 Our case emphasizes the fact that a simple bedside test like Tzanck smear can be crucial in early diagnosis and also, if there is a high index of suspicion of HSV infection, systemic antiviral treatment should be started without delay in order to prevent serious complications and achieve clinical cure.


1. Lee GH, Kim YM, Lee SY, Lee JS, Park YL, Whang KU. A case of eczema herpeticum with hailey-hailey disease. Ann Dermatol. 2009;21:311–4.

2. Burge SM. Hailey-Hailey disease: the clinical features, response to treatment and prognosis. Br J Dermatol. 1992;126:275–82.

3. Wollenberg A, Zoch C, Wetzel S, Plewig G, Przybilla B. Predisposing factors and clinical features of eczema herpeticum: a retrospective analysis of 100 cases. J Am Acad Dermatol. 2003;49:198–205.

4. Zamperetti M, Pichler M, Perino F, Eisendle K. Acase of Hailey-Hailey herpeticum. J Dtsch Dermatol Ges J Ger Soc Dermatol JDDG.

100 comments on “Significance of a simple bedside test in the early diagnosis of a rare case of Kaposi’s varicelliform eruption

  1. Some, but not all 18, epidemiological studies have reported a higher rate of hypothyroidism in breast cancer patients in comparison to the general population 19, 20, 21, 22, 23, 24, possibly as a result of shared risk factors such as older age and female sex 25, 26 and cancer treatments such as radiotherapy to the lymph nodes which has been posited to damage thyroid cells directly 27, 28, and in combination with systemic therapies 23, 29 buy cialis usa

  2. Using this technique, we demonstrate that multiple subpopulations exist within a well studied and putatively homogeneous stem cell population, murine long term hematopoietic stem cells LT HSCs propecia tablets for sale optivar volo italia cipro diretto But the new IMF loan never materialized and Hungary s announcement Гў and the months of negotiations with the Fund that followed Гў were considered by analysts as part of a delaying tactic to gain time until the international financial situation stabilized and the country s bonds again became attractive to investors

  3. Your article gave me a lot of inspiration, I hope you can explain your point of view in more detail, because I have some doubts, thank you.

  4. Your article gave me a lot of inspiration, I hope you can explain your point of view in more detail, because I have some doubts, thank you.

  5. Find the latest technology news and expert tech product reviews. Learn about the latest gadgets and consumer tech products for entertainment, gaming, lifestyle and more. https://axget.com/

  6. ZenCortex Research’s contains only the natural ingredients that are effective in supporting incredible hearing naturally.A unique team of health and industry professionals dedicated to unlocking the secrets of happier living through a healthier body. https://zencortex-try.com/

  7. Dentitox Pro is a liquid dietary solution created as a serum to support healthy gums and teeth. Dentitox Pro formula is made in the best natural way with unique, powerful botanical ingredients that can support healthy teeth. https://dentitox-us.com/

  8. Progenifix is designed to help maximize weight loss results using a mixture of natural, science-backed ingredients. The formula also has secondary benefits, including promoting overall wellness and vitality and assisting your immune system. https://progenifix-web.com/

  9. Gut Vita™ is a daily supplement that helps consumers to improve the balance in their gut microbiome, which supports the health of their immune system. It supports healthy digestion, even for consumers who have maintained an unhealthy diet for a long time. https://gutvita-us.com/

  10. Neuro-Thrive is a brain health supplement that claims to promote good memory and thinking skills and better quality sleep. This nootropic supplement achieves its cause with its potent blend of natural compounds and extracts that are proven to be effective in sharpening mental acuity. https://neurothrive-web.com/

  11. Are you tired of looking in the mirror and noticing saggy skin? Is saggy skin making you feel like you are trapped in a losing battle against aging? Do you still long for the days when your complexion radiated youth and confidence? https://refirmance-web.com/

  12. Keravita Pro™ is a dietary supplement created by Benjamin Jones that effectively addresses nail fungus and hair loss, promoting the growth of healthier and thicker nails and hair. The formula is designed to target the underlying causes of these health issues and provide comprehensive treatment. https://keravitapro-web.com

  13. Arctic blast is a powerful formula packed with natural ingredients and can treat pain effectively if you’re struggling with chronic pain. You can say goodbye to muscle cramps with this natural pain reliever in less than a minute. It helps with arthritic pain, blood circulation, and joint pain. It gives long-lasting effects that replace the need to go to surgery. https://arcticblast-web.com

  14. PotentStream is designed to address prostate health by targeting the toxic, hard water minerals that can create a dangerous buildup inside your urinary system It’s the only dropper that contains nine powerful natural ingredients that work in perfect synergy to keep your prostate healthy and mineral-free well into old age. https://potentstream-web.com/

Leave a Reply

Your email address will not be published. Required fields are marked *