Herpetic whitlow of the toe presenting with severe viral cellulitis

Abstract

Herpetic whitlow of the toe is a common infection in an uncommon location, leading it to be frequently misdiagnosed; however, as the virus responds well to conservative management or antivirals alone, proper identification is necessary to prevent unnecessary interventions. We present a case of herpetic whitlow of the toe with an unusually ominous appearance in a previously healthy and otherwise well-appearing child. This case illustrates the spectrum of herpetic whitlow's clinical presentations and enourages consideration of the disease even for atypical location and severity.

Toddler with a sore forefinger

“…Incision and drainage is contraindicated in HW as it increases the risk of viraemia, secondary bacterial infection and HSV encephalitis 4 . The ominous bluish‐grey discolouration of the distal phalanx made us seek a surgical opinion but a definitive diagnosis of HW helped to prevent intervention.…”

Monkeypox presenting as a facial abscess

“…3 We also made the patient aware of the risk of infection spreading from the finger to the hand, causing viral cellulitis. 4 At review, the patient had made a full recovery though he was a little lighter! This patient was prescribed multiple courses of antibiotics and passed from clinic to clinic without a formal diagnosis.…”

An Unexpected Complication of Gingivostomatitis

“…1,2 Accurate diagnosis of HW may prevent unnecessary antibiotic treatment and potential harm from surgical debridement, which should be avoided in the absence of secondary bacterial infection. 2,3 Although the diagnosis is clinical, laboratory analyses may be necessary. 1 Though specific treatment is not necessary in healthy children, acyclovir may attenuate symptoms and shorten the course of the infection, especially in cases of primary infection or multifocal disease.…”

“…1 Though specific treatment is not necessary in healthy children, acyclovir may attenuate symptoms and shorten the course of the infection, especially in cases of primary infection or multifocal disease. 2,3 In this case, the diagnosis of HW was considered after a few days of worsening inflammatory signs and oral acyclovir was initiated. Polymerase chain-reaction of the fluid was positive for herpes simplex virus type 1 (HSV-1) and bacterial culture isolated a methicillinsensitive Staphylococcus aureus.…”