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Paediatric recurrent herpetic whitlow

Ramnik Patel1, Hemant Kumar, Bharat More

  • 1Department of Paediatric Urology, University College London Hospitals NHS Foundation Trust, London, UK. ramnik@doctors.org.uk

BMJ Case Reports
|August 2, 2013
PubMed

Insights

A rare case of recurrent painful blisters in a child was initially misdiagnosed, leading to harmful treatments. Early diagnosis and appropriate antiviral therapy (acyclovir) are crucial for recovery and preventing complications.

Area of Science:

  • Pediatric Dermatology
  • Virology
  • Infectious Diseases

Background:

  • Recurrent painful blisters on the middle phalanx of a finger can be challenging to diagnose in young children.
  • Initial misdiagnosis as bacterial whitlow led to inappropriate interventions.

Observation:

  • A 15-month-old immunocompetent female child presented with recurrent painful blisters on her left ring finger.
  • Lesions were initially treated as whitlow with incision and drainage, followed by harmful interventions like cigarette burns.

Findings:

  • Diagnosis was confirmed as a viral infection via skin scraping and virology culture.
  • The patient achieved recovery with topical and systemic acyclovir, with a recurrence at age 4 also responding to acyclovir therapy.

Implications:

  • Highlights the critical importance of accurate diagnosis in pediatric dermatology to avoid iatrogenic harm and child protection concerns.
  • Emphasizes the need for prompt and correct antiviral treatment, particularly acyclovir, for viral blistering conditions.
  • Underscores the potential dangers of misdiagnosis and inappropriate management, especially concerning cross-infection risks in vulnerable populations.

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