A Case Report of Herpetic Whitlow with Positive Kanavel’s Cardinal Signs: A Diagnostic and Treatment Difficulty
Herpetic whitlow is an acute viral infection of the hand caused by either herpes simplex virus (HSV) 1 or 2. Its characteristic findings are significant pain and erythema with overlying nonpurulent vesicles. The differential diagnosis includes flexor tenosynovitis. We present a case of recurrent inf...
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| Format: | Article |
| Language: | English |
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Wiley
2014-01-01
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| Series: | Case Reports in Orthopedics |
| Online Access: | http://dx.doi.org/10.1155/2014/906487 |
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| author | Milos Brkljac Samer Bitar Zafar Naqui |
| author_facet | Milos Brkljac Samer Bitar Zafar Naqui |
| author_sort | Milos Brkljac |
| collection | DOAJ |
| description | Herpetic whitlow is an acute viral infection of the hand caused by either herpes simplex virus (HSV) 1 or 2. Its characteristic findings are significant pain and erythema with overlying nonpurulent vesicles. The differential diagnosis includes flexor tenosynovitis. We present a case of recurrent infection of the middle finger in an immunocompetent 19-year-old girl. Multiple painful pustules with tracking cellulitis were partially treated by oral antibiotics. A recurrence with positive Kanavel’s signs suggested flexor tenosynovitis at seven months. Her symptoms improved transiently following emergent surgical open flexor sheath exploration and washout however, she required two further washouts; at eleven and thirteen months to improve symptoms. Viral cultures were obtained from the third washout as HSV infection was disclosed from further history taking. These were positive for HSV2. Treatment with acyclovir at thirteen months after presentation led to a complete resolution of her symptoms with no further recurrences to date. This rare case highlights the similarity in presentation between flexor sheath infection and herpetic whitlow which can lead to diagnostic confusion and mismanagement. We emphasise the importance of careful past medical history taking as well as considering herpetic whitlow as a differential diagnosis despite the presence of strongly positive Kanavel’s signs. |
| format | Article |
| id | doaj-art-8f33f2ed31914da397721052a388df47 |
| institution | Kabale University |
| issn | 2090-6749 2090-6757 |
| language | English |
| publishDate | 2014-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Orthopedics |
| spelling | doaj-art-8f33f2ed31914da397721052a388df472025-02-03T01:13:12ZengWileyCase Reports in Orthopedics2090-67492090-67572014-01-01201410.1155/2014/906487906487A Case Report of Herpetic Whitlow with Positive Kanavel’s Cardinal Signs: A Diagnostic and Treatment DifficultyMilos Brkljac0Samer Bitar1Zafar Naqui2Salford Royal Foundation Trust, Manchester, UKSalford Royal Foundation Trust, Manchester, UKSalford Royal Foundation Trust, Manchester, UKHerpetic whitlow is an acute viral infection of the hand caused by either herpes simplex virus (HSV) 1 or 2. Its characteristic findings are significant pain and erythema with overlying nonpurulent vesicles. The differential diagnosis includes flexor tenosynovitis. We present a case of recurrent infection of the middle finger in an immunocompetent 19-year-old girl. Multiple painful pustules with tracking cellulitis were partially treated by oral antibiotics. A recurrence with positive Kanavel’s signs suggested flexor tenosynovitis at seven months. Her symptoms improved transiently following emergent surgical open flexor sheath exploration and washout however, she required two further washouts; at eleven and thirteen months to improve symptoms. Viral cultures were obtained from the third washout as HSV infection was disclosed from further history taking. These were positive for HSV2. Treatment with acyclovir at thirteen months after presentation led to a complete resolution of her symptoms with no further recurrences to date. This rare case highlights the similarity in presentation between flexor sheath infection and herpetic whitlow which can lead to diagnostic confusion and mismanagement. We emphasise the importance of careful past medical history taking as well as considering herpetic whitlow as a differential diagnosis despite the presence of strongly positive Kanavel’s signs.http://dx.doi.org/10.1155/2014/906487 |
| spellingShingle | Milos Brkljac Samer Bitar Zafar Naqui A Case Report of Herpetic Whitlow with Positive Kanavel’s Cardinal Signs: A Diagnostic and Treatment Difficulty Case Reports in Orthopedics |
| title | A Case Report of Herpetic Whitlow with Positive Kanavel’s Cardinal Signs: A Diagnostic and Treatment Difficulty |
| title_full | A Case Report of Herpetic Whitlow with Positive Kanavel’s Cardinal Signs: A Diagnostic and Treatment Difficulty |
| title_fullStr | A Case Report of Herpetic Whitlow with Positive Kanavel’s Cardinal Signs: A Diagnostic and Treatment Difficulty |
| title_full_unstemmed | A Case Report of Herpetic Whitlow with Positive Kanavel’s Cardinal Signs: A Diagnostic and Treatment Difficulty |
| title_short | A Case Report of Herpetic Whitlow with Positive Kanavel’s Cardinal Signs: A Diagnostic and Treatment Difficulty |
| title_sort | case report of herpetic whitlow with positive kanavel s cardinal signs a diagnostic and treatment difficulty |
| url | http://dx.doi.org/10.1155/2014/906487 |
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