Kaposi's Varicelliform Eruption in Phenytoin-Induced Erythroderma.

A 48-year-old female presented with 15-days-duration of erythroderma after taking phenytoin. She had erosions covered with thick yellow crusts around the oral cavity, started 12 days after erythroderma. [Figure 1]. Systemic examination and blood investigations were within normal limits. The patient was treated for erythroderma and her general condition improved, however, the perioral erosions increased in number with thick crusting. On further probing, the patient admitted to picking at the lesions and also provided a history of few tiny fluid-filled lesions around the mouth a few days prior to admission. Patient had no previous history of fluid filled vesicles around oral cavity. A Tzanck smear was taken from the base of the lesions after removal of the crusts, which revealed epithelial multinucleated giant cells [Figure 2]. A diagnosis of Kaposi's varicelliform eruption (KVE) was considered and the patient was subsequently put on acyclovir to which she responded well [Figure 3].

Figure 1

Multiple erosions covered with thick yellow crusts presenting around the oral cavity

Figure 2

Tzanck smear showing multinucleate giant cells. (papanicolaou stain 10×)

Figure 3

Patient 15 days after treatment with antivirals showing complete healing of the lesions with scars

KVE refers to a widespread cutaneous infection with a virus that normally causes localized or mild vesicular eruptions, occurring in a patient having pre-existing skin disease. Most cases are due to herpes simplex virus (HSV) infections, however, coxsackie A16 and vaccinia may also be responsible in a minority of patients. Susceptible dermatoses include Darier's disease, pemphigus foliaceus and with rare reports in association with Hailey–Hailey disease, Grover's disease, ichthyosis vulgaris, congenital ichthyosiform erythroderma, allergic contact dermatitis, irritant contact dermatitis, psoriasis, pityriasis rubra pilaris, cutaneous T-cell lymphoma, Sézary syndrome, rosacea, drug eruption, and staphylococcal scalded skin syndrome.[1] Ferrari et al. reported 19 cases of KVE which included four adults, familial cases, and previously healthy patients, and highlighted the importance of early diagnosis and treatment.[2]

The present case is reported to raise awareness among treating dermatologists about this condition and the importance of Tzanck smear.

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