Kaposi's Varicelliform Research Articles

KAPOSI'S VARICELLIFORM ERUPTION; A PRIMARY INFECTION WITH HERPES SIMPLEX VIRUS

Five cases of Kaposi's varicelliform eruption are reported of which three were children and two were adults. The patients had been exposed to one or more members of the immediate family who had herpes simplex infection. The virus of herpes simplex was recovered from two children and one adult. In all five cases the neutralization index of their sera against herpes virus, little higher than that of control serum during the acute phase of their illness, rose during convalescence. Corroborative evidence is obtained from a study of the above cases that Kaposi's varicelliform eruption is in all probability a manifestation of primary infection with herpes simplex virus in persons with eczema.

KAPOSI'S VARICELLIFORM ERUPTION

TOWARD the end of the last century Kaposi¹described a syndrome in children. The young patients experienced an eruption and a febrile reaction as a complication of preexisting atopic dermatitis. Lesions usually appeared over the old atopic dermatitis, but occasionally invaded the neighboring healthy skin. The lesions went through various stages of vesiculation, umbilication, desiccation and rupture. The acute lesions appeared in recurrent crops for many days, and when they finally healed only signs of the original atopic dermatitis persisted. No mention was made in the original description of lymph node involvement, which was a common observation in subsequent reports of similiar cases. Shortly thereafter, under the title of "Pustulosis acuta varioliformis," Juliusberg²described a fatal case in which there were lesions similar to those of Kaposi's varicelliform eruption. A similar disease picture has been described by many authors under the name of eczema vaccinatum. Many of these

KAPOSI'S VARICELLIFORM ERUPTION

SINCE 1941 increased attention has been given to the cause of Kaposi's varicelliform eruption. Esser 1 and Seidenberg 2 in 1941 first contributed evidence that the virus of herpes simplex causes Kaposi's varicelliform eruption in at least some cases. Dermatologic attention has not previously been called to the publication by Esser, who described a small epidemic of this disease in an infants' ward, where 4 children became severely ill, 1 dying as a result of the infection. In 2 of Esser's cases the herpetic virus was recovered and identified by Seidenberg. Other investigators have since published reports of cases in which there has been suggestive or conclusive evidence incriminating the herpetic virus. Conditions of war kept the earlier reports from general attention of American dermatologists, but Barton and Brunsting 3 soon described the results of experimental studies in 2 cases of Kaposi's varicelliform eruption. At about the same time, Lynch

Etiology of kaposi's varicelliform eruption

Summary A filtrable virus (Berkefeld V-13 “fine” and N filters) isolated from the skin lesions of a 15-month-old child, showing a clinical picture typical of Kaposi's varicelliform eruption, was identified as a member of the herpes group. It is noteworthy that the virus was isolated not only by means of the rabbit's cornea but also directly on the chorioallantois of the developing hen's egg. The latter finding would seem to exclude any possibility that a latent herpes virus might have been reinactivated in the rabbit by experimental manipulation. While these investigations were in progress, it came to our attention that strains of herpes were isolated and identified in two other laboratories by Wenner21 and by Barton and Brunsting,22 working independently. It seems logical to conclude that a strain of herpes virus is the etiologic agent involved in at least some of the cases diagnosed as Kaposi's varicelliform eruption.

GENERALIZED VACCINIA IN AN ECZEMATOUS CHILD

Generalized vaccinia is an uncommon but serious complication of vaccination, surveys placing the incidence at 1 in 20,000 to 1 in 96,000 vaccinations and the case fatality rate at 12 to 30 per cent. 1 About two thirds of the persons in whom this complication occurs have diseases of the skin; many are children with eczema. Therefore, although the disease itself is uncommon, it constitutes a real danger to persons with cutaneous diseases, and warnings have been sounded against vaccination of such persons and against their exposure to recently vaccinated persons. The subject has been discussed in several recent reviews. 2 Generalized vaccinia in persons with eczema has been called eczema vaccinatum. Clinically similar conditions in persons with eczema or other cutaneous diseases have been called Kaposi's varicelliform eruption or pustulosis varioliformis acuta when there was no history of preceding vaccination or of contact with recently vaccinated persons, or when

CIII. KAPOSI'S VARICELLIFORM ERUPTION

Five cases have been observed the features of which conform to the details of the varicelliform eruption as described by Kaposi.¹Because of the supposed rarity of this disease and the disagreement concerning its causation and classification, a report and a discussion of these cases were deemed worth while. Some authors consider the disease to be a form of eczema vaccinatum; one writer²recently proposed a new title, dermatitis vaccinica, to include all the allied processes, namely, eczema vaccinatum, generalized vaccinia, pustulosis acuta varioliformis³and Kaposi's varicelliform eruption. Study of these 5 cases leads us to believe that this striking eruption is unique and deserves to maintain its identity as a separate disease. Investigation indicates that the etiologic agent is a virus, probably a strain of the virus of herpes simplex. REPORT OF CASES Case1.—M. L., a 20 year old

A Filterable Virus Isolated from a Case of Kaposi's Varicelliform Eruption

A Filterable Virus Isolated from a Case of Kaposi's Varicelliform Eruption

The treatment of Kaposi's varicelliform eruption with sulfonamide drugs

The treatment of Kaposi's varicelliform eruption with sulfonamide drugs

DERMATITIS VACCINICA

The disease reported in this communication as dermatitis vaccinica has been called by many names, the best known perhaps being Kaposi's varicelliform eruption, pustulosis vacciniformis acuta (Freud) and eczema vaccinatum. The other synonyms include pustulosis acuta varioliformis (Juliusberg), postvaccinal eruption, vaccine generalisee , generalized vaccinia, vaccinoderma, vaccinosi accidentale (Venturi), eczema varicellatum (or variolatum) and eczema herpetiforme. The relationship of dermatitis vaccinica to vaccinia virus is denied by many authors. Some believe it is due to staphylococci; others, that it is a herpetic eruption. This uncertainty is due to the fact that in many cases the inoculated cornea of the rabbit does not show the Guarnieri bodies, that a history of contact with a recently vaccinated person is not obtained or that in some cases a subsequent vaccination of the patient gives positive results. However, the clinical course and the histologic structure of the pustule are decidedly different from known staphylococcic infections,

KAPOSI'S VARICELLIFORM ERUPTION

As a definite entity occupying a place among accepted cutaneous diseases, Kaposi's varicelliform eruption may not yet have acquired recognition. As a clearcut picture, easily recognizable as a certain complication of infantile eczema, it would seem to deserve a niche among the rarer dermatoses. The instances reported by Brown 1 and McLachlan 2 and accompanied with excellent photographs clearly informed one of us (E. F. C.) as to the nature of two cases which stood out as well recalled but baffling experiences of dispensary work. Perusal of literature dealing with infantile eczema and with other types of suggestively umbilicated outbreaks, together with informal conversations with several well informed dermatologists about the matter, had been productive of no results. Nevertheless the syndrome seemed so clearcut that it was felt that the condition was worthy of description and probably one already set forth in print. The Scotch dermatologists' articles settled the question.