A 6-month-old infant presented with multiple papules & exudative lesions on the face, scalp, trunk and few vesicles on palms and soles for 2 weeks. His mother has h/0 itchy lesions. The most likely diagnosis is –
**Question:** A 6-month-old infant presented with multiple papules & exudative lesions on the face, scalp, trunk and few vesicles on palms and soles for 2 weeks. His mother has h/0 itchy lesions. The most likely diagnosis is –
A. Discoid Lupus Erythematosus
B. Eczema
C. Herpes Simplex Virus
D. Varicella Zoster Virus
**Correct Answer:** D. Varicella Zoster Virus
**Core Concept:**
Varicella-Zoster Virus (VZV) is the etiological agent responsible for chickenpox (varicella) and its reactivation, which results in shingles (herpes zoster). It is a double-stranded DNA virus belonging to the Herpesviridae family. The clinical presentation of VZV infection includes vesicles and papules, which are typically grouped in a characteristic pattern, known as "bull's eye" due to the presence of a central, umbilicated, and necrotic center, surrounded by a red, oedematous, and erythematous margin.
**Why the Correct Answer is Right:**
In this scenario, the most fitting diagnosis is Varicella Zoster Virus (VZV) infection. The clinical features mentioned in the question, including the age of the patient (6 months), the distribution of lesions (primarily affecting face, scalp, trunk, and palms/soles), and the duration of symptoms (2 weeks), align with the typical presentation of VZV infection.
**Why Each Wrong Option is Incorrect:**
A. Discoid Lupus Erythematosus (DLE) is an autoimmune disease affecting adults, rarely children, and presents with scaly plaques rather than vesicles and papules.
B. Eczema (atopic dermatitis) is an inflammatory skin condition mainly affecting infants and young children, causing widespread, pruritic, and vesicular rash, but the clinical presentation differs significantly from VZV infection.
C. Herpes Simplex Virus (HSV) causing chickenpox usually presents with a macular stage followed by papular and vesicular stage, followed by an eczematous stage. The age of the patient is also not appropriate for HSV infection.
D. Varicella-Zoster Virus (VZV) infection, also known as chickenpox, is a childhood infection caused by VZV. It is usually self-limiting and presents with vesicles and papules, particularly affecting infants and young children. In this case, the correct answer is D because the clinical presentation and age of the patient align with VZV infection, which is the correct answer.
**Clinical Pearls:**
1. In infants and young children, VZV infection presents as chickenpox (acute phase) and subsequently shingles (post-herpetic neuralgia). The typical presentation of chickenpox includes:
- Pruritic rash (itchy skin lesions)
- Erythematous macules and papules (