Abstract
We describe a rare case of a preterm neonate presenting at birth with extensive epidermal skin loss of over 90% due to disseminated herpes simplex virus type one infection. Differential diagnosis included aplasia cutis and epidermolysis bullosa. Serum PCR and mouth swabs confirmed HSV type one, and the patient required three weeks of treatment with intravenous aciclovir, followed by oral aciclovir. We describe the management challenges and give practical solutions applicable to the care of a neonate presenting with widespread skin loss due to any aetiology.
Highlights
Rebecca J Calthorpe,1 Emma Spencer,1 Jane C Ravenscroft,2 Ting S Tang,2 Anna E Martinez,3 and Anjum Deorukhkar1
We describe a rare case of a preterm neonate presenting at birth with extensive epidermal skin loss of over 90% due to disseminated herpes simplex virus type one infection
Introduction is report describes a rare case where a thirty-week gestation neonate had over 90% epidermal skin loss at delivery due to disseminated, transplacentally acquired herpes simplex virus (HSV) type one. is resulted in complex neonatal care that was atypical to a baby of this gestation
Summary
Intravenous access may be difficult to obtain and secure; maximise the duration of central line access with careful monitoring. Fluids ere will be excessive fluid loss via the skin; fluid balance monitoring should be documented hourly to aid decisions on fluid management. If central venous access has been obtained, parenteral nutrition can be prescribed until milk feeds are commenced. Rapid escalation of analgesia with drugs not typically prescribed in neonates may be needed; expert pharmacy advice should be accessed where available. In this case, phototherapy was implemented effectively to treat jaundice with no obvious exacerbation to the skin. Consider HSV infection in a neonate presenting with widespread skin loss and obtain samples for viral PCR. Administer intravenous aciclovir early. ere is an increased risk of infection; have a low threshold for commencing antimicrobial treatment if there are signs of infection
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