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A man with an infected finger: a case report
Pieter J Gathier1,2, Titus J A Schönberger3
1Jeroen Bosch Ziekenhuis 's-Hertogenbosch, Henri Dunantstraat 1, 5223 GZ, 's-Hertogenbosch, The Netherlands. pjgathier@gmail.com.
Introduction:
Whitlow is an infection of a finger or around the fingernails, generally caused by bacterium. However, in rare cases, it may also be caused by the herpes simplex virus. As herpetic whitlow is not seen often, it may go under-recognised or be mistaken for a different kind of infection of the finger. Delayed recognition and/or treatment puts patients at risk of complications ranging from superinfection to herpetic encephalitis.
Case Presentation:
A 23-year-old Caucasian man with no medical history was referred by his primary care physician because of erythema and swelling of the little finger of his left hand. The primary care physician had already treated him with the oral antibiotic Augmentin® (amoxicillin-clavulanic acid) and incision of the finger, but this had not resolved his complaints. He had multiple vesicles on the finger, which led to the diagnosis of herpetic whitlow, which we confirmed by polymerase chain reaction testing. All cutaneous abnormalities disappeared after treatment.
Conclusions:
Whitlow is rarely caused by the herpes simplex virus, but this disease requires a swift recognition and treatment to prevent complications. This case serves to emphasise that not all whitlow is caused by a bacterial infection, and that it is important to differentiate between herpetic and bacterial whitlow, as these diseases require a different treatment.
Insights
Herpetic whitlow, a rare viral finger infection, can be mistaken for bacterial infections. Prompt diagnosis and antiviral treatment are crucial to prevent severe complications like encephalitis.
Area of Science:
- Dermatology
- Infectious Diseases
- Virology
Background:
- Whitlow is a common finger infection, usually bacterial.
- Herpetic whitlow, caused by the herpes simplex virus, is rare and often misdiagnosed.
- Delayed treatment of herpetic whitlow can lead to serious complications, including encephalitis.
Observation:
- A case of a 23-year-old man with a presumed bacterial whitlow initially treated with antibiotics and incision.
- The patient presented with finger erythema, swelling, and multiple vesicles, unresponsive to initial treatment.
- Herpetic whitlow was diagnosed based on clinical presentation and confirmed by polymerase chain reaction testing.
Findings:
- Herpetic whitlow was confirmed in a patient with symptoms initially attributed to bacterial infection.
- Polymerase chain reaction testing verified the presence of herpes simplex virus.
- The patient's symptoms resolved completely after appropriate antiviral treatment.
Implications:
- Highlights the importance of considering viral causes for whitlow, even when bacterial infection is suspected.
- Emphasizes the need for accurate differentiation between herpetic and bacterial whitlow for effective treatment.
- Underscores the potential for severe complications if herpetic whitlow is not promptly recognized and treated.
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