Fulminant Eczema Herpeticum Associated With Baricitinib Treatment

A 22-year-old man presented to our department in markedly reduced general condition. For a week, he had been suffering from painful vesicles and areas of erosion on his face, neck and upper body (Figure a). For the last year, he had been treated for atopic dermatitis with the Janus kinase (JAK) inhibitor baricitinib, which blocks the type I interferon signaling pathway, at a dose of 4 mg/day. Swab testing detected a herpes simplex virus (HSV) type 1 infection, confirming the diagnosis of eczema herpeticum (or Kaposi‘s varicelliform eruption). As the patient became increasingly somnolent, he was transferred to an intermediate care unit and baricitinib treatment was temporarily discontinued. He received acyclovir at a dose of 10 mg/kg body weight/day intravenously and polyhexanide solution topically. Over a period of eight days, symptoms improved significantly and the lesions healed without scarring (Figure b). Patients with atopic dermatitis generally are at increased risk of developing eczema herpeticum. Baricitinib, which was approved in Europe in 2020 for the treatment of atopic dermatitis besides other conditions, is associated with HSV type 1 infections in 3% of patients and in 0.2–2.8% of patients with eczema herpeticum, a condition which should be diagnosed and treated as early as possible.

Figure

Dr. med. Jan-Malte Placke, Prof. Dr. med. Joachim Dissemond, Klinik für Dermatologie, Universitätsklinikum Essen, [e-mail]

Dr. med. Emmanouil Gratsias, Klinik für Dermatologie, Vivantes Klinikum Neukölln, Berlin

Conflict of interest: The authors declare no conflict of interest.

Translated from the original German by Ralf Thoene, MD.

Cite this as: Placke JM, Gratsias E, Dissemond J: Fulminant eczema herpeticum associated with baricitinib treatment. Dtsch Arztebl Int 2024; 121: 617. DOI: 10.3238/arztebl.m2024.0024