Secondary Bacterial Paronychia After Herpetic Whitlow

Secondary Bacterial Paronychia after Herpetic Whitlow

Department of Plastic and Reconstructive Surgery, Gachon University Gil Medical Center, South Korea Ji Hun Kim, M.D., Hyung Jun Min, M.D., Young Woo Cheon, M.D., Ph.D., Yang Woo Kim, M.D., Ph.D., Woo Sik Pae, M.D.

Introduction Methods Results Conclusions

Whitlow is an infection of the tip of fingers, difficult A 24-year-old woman was referred by primary care It is important to differentiate between herpetic Herpetic whitlow is a viral infection of HSV, to distinguish paronychia. In rare cases, it may physician because of erythema, swelling, multiple whitlow and other bacterial infections of finger occurring primarily on the distal end of the finger. also be caused by Herpes Simplex Virus (HSV). It vesicles, and throbbing pain of the left middle finger. such as felon or paronychia. These diseases This painful infection usually occurs 2 to 14 days is important to differentiate between herpetic Patient was a nurse working in the intensive care require different treatments in each cases. Due to after contact with HSV and has a maturity period whitlow and other bacterial infection of finger such unit and had a contact history with a varicella zoster the nature of HSV infection, herpetic whitlow has of up to 14 days. With a close inspection, as felon or paronychia, because these diseases patient a few days ago. Although the physician resolution time for about 3 weeks without diagnosis can be made easily with patient’s require a different treatment. Diagnosis of whitlow prescribed Augmentin® (amoxicillin-clavulanic acid) treatment. Therefore, mistaking the clear vesicular history, the nature of the illness, and physical can be made with careful listening of the patient's for 1 week before transfer the patient, symptoms discharge to pus can lead an unnecessary I&D in examination. past history and clinical symptoms. We introduce persisted and became worse. There was mucoid the case of herpetic whitlows. On the contrary, in a case to emphasize a close inspection to patient discharge through primary wound near fingernail. the case of felon or paronychia, I&D and Figure 2 with fingertip infection. Also, there was spontaneous clear secretion from debridement of necrotic tissue is an essential vesicles. On the basis of the clinical appearance process in treatment. Often misdiagnosis and Figure 1 and past history, we considered herpetic whitlow delayed treatment of herpetic whitlow cause with secondary bacterial infection. So, after I&D, secondary bacterial infections that are difficult to Zovirax® (acyclovir cream) mixed Bactoban® treat. For this reason, the most important medical (mupirocin calcium cream) was applied(Fig. 1). And procedure, but easy to overlook, is the careful we added Famvir® (Famciclovir) for medication. listening of the patient's past history when treating After treatment for 2 weeks, cutaneous wound was a patient with vesicles on the finger. almost disappeared.

Healed status of wound, after 3 months of treatment. Acute Herpetic whitlow with vesicles on middle phalanx, Lt. (After I&D with nail extraction)