A 16-day-old neonate presents with clusters of vesicles confined to the skin of the right arm and trunk. He is afebrile, feeding well, and has no seizures. CSF shows 4 cells/mm3 with normal glucose and protein, liver enzymes are normal, and no visceral involvement is seen on evaluation. What is the classification and required parenteral treatment duration?

• A CNS disease; intravenous acyclovir for 14 days
• B Skin, eye, and mouth disease; intravenous acyclovir for 21 days
• C Disseminated disease; intravenous acyclovir for 21 days
• D Skin, eye, and mouth disease; intravenous acyclovir for 14 days ✓

Explanation

Neonatal HSV is classified as skin-eye-mouth (SEM), CNS, or disseminated disease based on involved sites. This infant has vesicular lesions with normal CSF, normal transaminases, and no visceral or neurologic signs, defining SEM disease, which is treated with intravenous acyclovir for 14 days. The 21-day course is required for CNS or disseminated disease, the tempting distractor, because relapse rates are higher with shorter therapy in those forms.

Reference: Nelson Textbook of Pediatrics, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.