Paediatric recurrent herpetic whitlow

Abstract

SUMMARYWe present a case of recurrent painful blisters of middle phalanx of the left ring finger of a 15-month-old previously healthy and immunocompetent female child. These lesions initially were confused with infective bacterial whitlow, treated with incision and drainage, and later with cigarette burns which led to referral to child protection team. Paediatric dermatologist finally diagnosed after scrapping and virology culture. The patient had recovery following full treatment with topical and systemic acyclovir. She presented again at the age of 4 with recurrence which required topical and systemic acyclovir therapy with good recovery. It is important to be aware of the danger of incorrect diagnosis, raising child protection concerns and management leading to danger of cross infection and serious illness especially in the immunocompromised patients. BACKGROUND

Characterization of Herpes Simplex Virus Infections Seen in the Pediatric Dermatology Office

“…Given the less common presentation, cutaneous HSV infection is commonly misdiagnosed as impetigo or herpes zoster . In a review of herpetic whitlow in children, 65% were initially misdiagnosed as having a bacterial infection . Likewise, 31% of the patients in our group had a prior diagnosis of impetigo, although combined HSV and bacterial infections are common .…”

Left extensive infection in the forearm caused by whitlow infected by mycobacterium tuberculosis

“…Milos et al [ 3 ] reported the whitlow infected by herpes simplex virus and emphasized the importance of exact diagnosis. Ramnik et al [ 4 ] also presented a rare case of 15-month child with recurrent herpetic whitlow. Here, we show a rare case on infected left forearm caused by recurrent whitlow infected by MTB.…”

“…Some authors [ 2 , 3 ] described patient with whitlow caused by herpes simplex virus. And Ramnik et al [ 4 ] presented a case of recurrent herpetic whitlow of a 15-month-old child. However, as far as we know, few reports on extensive infected forearm caused by whitlow was infected by mycobacterium tuberculosis (MTB).…”

Hand Infections

“…The use of oral acyclovir can be used in immunocompetent patients with recurrent disease or primary disease at multiple sites whereas topical acyclovir therapy may be of benefit for those with primary herpetic whitlow. 33 The recurrence rate is 20%. 33 Deep Infections…”