A 2-year-old boy with a known history of atopic dermatitis presents with fever and multiple clustered, painful vesicles on the right cheek and perioral area for 2 days. Some lesions have coalesced into erosions with hemorrhagic crusting. Tzanck smear of a vesicle base shows multinucleated giant cells. Which of the following is the most likely diagnosis?
- A Eczema herpeticum ✓
- B Impetigo
- C Varicella
- D Disseminated herpes zoster
Explanation
Eczema herpeticum is a disseminated herpes simplex virus infection that occurs in patients with atopic dermatitis. It presents with clustered, painful vesicles that evolve into characteristic punched-out erosions, often with systemic symptoms such as fever. Tzanck smear of the vesicle base shows multinucleated giant cells, confirming herpesvirus infection. Impetigo would show honey-colored crusts and Gram-positive cocci on Gram stain. Varicella produces generalized vesicles on an erythematous base, not localized to the face. Disseminated herpes zoster follows a dermatomal distribution.
Reference: Nelson Textbook of Pediatrics, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.