Undiagnosed Darier’s disease comorbid with ambiguous viral infection.

Introduction: Darier’s disease (DD) is a rare autosomal dominant genodermatosis characterized by hyperkeratotic papules, primarily located on seborrheic areas as well as with palmoplantar, nail or oral mucosa involvement. The course of the disease is chronic with the possible occurrence of coinfection, most commonly with the herpes simplex virus. Each new infection can significantly intensify the symptoms. Case description: A 42-year-old patient presented with a prolonged history of undiagnosed brownish-grey papules on the limbs and trunk, worsening in the summer was admitted to the dermatology department, to diagnose and treat the one-week history of skin lesions on his arms, chest, and neck, and partially face. Lesions were more intensified on the left side, initially displaying as intense erythema, then covered with multiple papules and grouped vesicles, accompanied by a burning sensation and fever. Laboratory tests showed elevated inflammatory markers. Ultrasonography revealed oedema of the subcutaneous tissue and enlarged cervical lymph nodes on the left side. In the blood culture methicillin-resistant Staphylococcus Aureus (MRSA) was detected. Systemic intravenous treatment with antibiotics and acyclovir resulted in slow clinical improvement with normalization in laboratory tests. Histopathological examination in correlation with the clinical data suggested a Poxviridae infection along with a typical Darier’s disease picture. Conclusions: Darier’s disease, particularly when complicated by cutaneous viral infections, may be misleading, as seen in this case. Eczema herpeticum, eczema vaccinatum, or other pox-zoonoses may explain the severe course observed. The histopathological examination is crucial for accurate diagnosis. [ABSTRACT FROM AUTHOR]