Kaposi Varicelliform Eruption Clinical Presentation

Updated: Dec 13, 2017
  • Author: David T Robles, MD, PhD, FAAD; Chief Editor: William D James, MD  more...
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Presentation

History

Kaposi varicelliform eruption (KVE) begins as a sudden eruption of painful; edematous; often crusted or hemorrhagic vesicles, pustules, or erosions in areas of the preexisting dermatosis. A delay in diagnosis often occurs because the eruption is confused with the underlying disease. The eruption continues to spread over 7-10 days and may be associated with a high temperature, malaise, and lymphadenopathy

The primary episode of KVE runs its course and heals in 2-6 weeks. The average duration of illness is 16 days.

Transmission occurs through contact with a person who is infected or by dissemination of primary or recurrent herpes. Recurrent episodes may also occur but are milder and not usually associated with systemic symptoms. Some studies have shown a high frequency of HSV DNA in the oral cavity of patients with KVE. [31] In severe cases of KVE, lesions may heal with scarring.

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Physical Examination

Umbilicated vesiculopustules that progress to punched-out erosions in the setting of a widespread dermatosis, as shown below, is virtually pathognomonic for Kaposi varicelliform eruption (KVE).

Infant with crusted, erythematous, umbilicated ves Infant with crusted, erythematous, umbilicated vesicles of eczema herpeticum and associated periorbital edema.
Kaposi varicelliform eruption occurring with under Kaposi varicelliform eruption occurring with underlying Darier disease.
Characteristic umbilicated vesiculopustules on the Characteristic umbilicated vesiculopustules on the thigh of a child with a preexisting atopic dermatitis.

The eruption is most commonly disseminated in the areas of dermatitis, with a predilection for the upper body and the head. Localized forms also exist. [32] The vesicles often become hemorrhagic and crusted and can evolve into extremely painful erosions with a punched-out appearance. These erosions may coalesce to form large denuded areas that frequently bleed and can become secondarily infected with bacteria.

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Complications

Systemic viremia with multiple-organ involvement is the major cause of morbidity and mortality in Kaposi varicelliform eruption (KVE). The organ systems involved include the liver, lungs, brain, gastrointestinal tract, and adrenal glands.

Septicemia from secondary bacterial infections of skin lesions also contributes to the morbidity and mortality of patients. Staphylococcus aureus, alone or mixed with group A beta-hemolytic streptococci, Pseudomonas aeruginosa, and Peptostreptococcus species were found to be the major isolates from patients with secondary bacterial infections.

When KVE due to herpes simplex virus (HSV) involves the face, a risk of ocular involvement leading to blepharitis, conjunctivitis, keratitis, and uveitis exists. Herpetic keratitis can lead to blindness due to stromal scarring. Interestingly, very few reported cases of ocular herpetic disease in KVE have occurred, even when positive conjunctival HSV cultures are present.

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