Abstract and Introduction
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.
Herpetic whitlow is an infrequently seen cause of infection of a finger. It is estimated to affect 2.5 per 100,000 people each year. It is caused by the herpes simplex virus type 1 (60%) or type 2 (40%). When it is seen, it is generally in patients with occupational hazards such as medical workers, dental workers, hairdressers or thumb-sucking children. As herpetic whitlow is rare, 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. In patients with specific occupational hazards or those with an atypical whitlow, physicians should be aware of herpetic whitlow.