Herpetic whitlow is a viral infection caused by the herpes simplex virus (HSV) types 1 or 2. It affects mostly the fingers and toes in children and is caused by autoinoculation from oral secretions. Because of the indicated prevalence, other herpetic whitlow places may go unnoticed. An uncommon case of palmar herpetic whitlow with delayed identification and viral lymphangitis is presented. The patient was transferred from another hospital with a three-day history of a probable left-hand abscess preceded by discomfort and itching in the left hand. According to Orthopedic Surgery, her first diagnosis was an erythematous, edematous, sensitive left palmar abscess with accompanying erythematous streaking up her forearm. An incision and drainage were used to treat the lesion surgically. Wound cultures were obtained during which “minimal drainage” was noted.
The lesion was vesicular during admission to the General Pediatrics Hospital service, and subsequent PCR samples were positive for HSV type 1, confirming the diagnosis of herpetic whitlow. Although she remained afebrile during her hospitalization and had negative wound cultures, researchers could not rule out a secondary bacterial infection owing to lymphangitis. As a result, she was discharged with oral antibiotics and advice on avoiding the recurrence of palmar lesions. Herpetic whitlow should be considered in the differential diagnosis of palmar lesions that seem vesicular to ensure proper therapy. Furthermore, these palmar lesions may be accompanied by lymphangitis, even if there is no evidence of bacterial infection.
Reference:bmcpediatr.biomedcentral.com/articles/10.1186/s12887-019-1828-5
