Gluten-Responsive Probable Pediatric Dermatitis Herpetiformis Mimicking Varicella in a Five-Year-Old Child: A Case Report
- AIOR Admin
- Jul 31
- 1 min read
Dian Andriani Ratna Dewi, Juliandra Firdaus, Khufitha Tasya, Sendang Tri Winayu, Sausan Maulida
Defense University, YARSI University, UKI University, Hasanuddin University
Background: Dermatitis herpetiformis (DH) is a gluten-associated autoimmune vesiculobullous dermatosis that is rare in children and may resemble infectious eruptions, particularly varicella. Case presentation: A 5-year-old boy presented with persistent, painful, and intensely pruritic grouped vesicles and tense bullae, predominantly affecting the posterior trunk and upper back. Although he had a history of varicella at 3 years of age, the current episode was not preceded by known varicella exposure, fever, or prodromal symptoms. The eruption was initially diagnosed as varicella due to its vesiculobullous morphology, and a 5-day course of acyclovir was administered. Over approximately 1 month of close monitoring, some lesions transiently dried and faded, but new grouped vesicles and bullae repeatedly appeared, became more widespread, and remained painful and pruritic. Recurrent flares were subsequently observed after ingestion of gluten-containing foods. Laboratory findings were unremarkable except for eosinophilia of 14% and a serum IgE of 91.88 IU/mL. IgA-based celiac serology, histopathology, and direct immunofluorescence were not performed because the parents declined. The clinical pattern, gluten-associated recurrence, lack of sustained response to acyclovir, and improvement with gluten avoidance supported a working diagnosis of gluten-responsive probable pediatric DH. Clinical improvement was achieved with lesion-directed topical therapy, symptomatic treatment, and a strict gluten-free diet. Conclusion: This case underscores a varicella-mimicking, gluten-responsive probable pediatric DH presentation and highlights the importance of transparent reporting of diagnostic uncertainty when confirmatory testing is unavailable.
Interesting case, especially because the recurrent Cool Games lesions and gluten-related flares made the initial varicella diagnosis questionable. The lack of confirmatory testing is an important limitation, but the clinical response to gluten avoidance shows why DH should be considered when a presumed infection keeps recurring.