Herpetic Whitlow Clinical Presentation

  • Author: Michael S Omori, MD; Chief Editor: Steven C Dronen, MD, FAAEM   more...
 
Updated: May 23, 2012
 

History

  • Patients present with complaints of pain and swelling of a finger, typically with characteristic vesicular lesions. The most commonly involved digits are the thumb and index fingers.
  • History of a prodrome of fever or malaise may precede the onset of symptoms by several days.
  • Similar previous problems in the same digit suggest that the patient is presenting with an episode of reactivation and recurrence.
  • Question patients about any recent possible exposure.
    • Health care workers with a history of exposure to oral or genital secretions are at risk.
    • Patients in the general population with a history of caring for or coming in contact with someone that has typical lesions are at risk.
    • Since autoinoculation is a common route, especially in children, ask about recent episodes consistent with herpes labialis or herpetic gingivostomatitis. In adults, inquire about a history of symptoms consistent with genital herpes.
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Physical

  • Involved finger is often exquisitely tender and quite edematous; however, in contrast to a felon, the pulp space usually is not tensely swollen.
  • Examination usually reveals the characteristic grouped vesicular lesions or ulcers with surrounding erythema.
  • Fluid within the vesicles is usually clear, although it may appear cloudy or hemorrhagic.
  • Extension of infectious process into subungual space may be observed.
  • Lymphangitic streaking and possibly adenopathy of the epitrochlear and axillary nodes may be found.
  • Preexisting herpetic lesions may be noted in oral cavity or genitals.
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Causes

  • As noted, health care workers are at risk due to possibility of exposure to virus-containing secretions from their patients.
  • Patients with other herpetic lesions, such as herpes labialis, herpetic gingivostomatitis, or genital herpes, are at risk due to autoinoculation.
  • Immunocompromised patients are at risk for primary infection, reactivation, and possibly systemic complications.
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Contributor Information and Disclosures
Author

Michael S Omori, MD  Attending Staff, Emergency Medicine Residency, St Vincent Mercy Medical Center; Acting Director, Pediatric Emergency Center, Mercy Children's Hospital; Clinical Assistant Professor, Department of Surgery, University of Toledo Medical Center, The University of Toledo College of Medicine

Michael S Omori, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Robin R Hemphill, MD, MPH  Associate Professor, Director, Quality and Safety, Department of Emergency Medicine, Emory University School of Medicine

Robin R Hemphill, MD, MPH is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Eric L Weiss, MD, DTM&H  Medical Director, Office of Service Continuity and Disaster Planning, Fellowship Director, Stanford University Medical Center Disaster Medicine Fellowship, Chairman, SUMC and LPCH Bioterrorism and Emergency Preparedness Task Force, Clinical Associate Progressor, Department of Surgery (Emergency Medicine), Stanford University Medical Center

Eric L Weiss, MD, DTM&H is a member of the following medical societies: American College of Emergency Physicians, American College of Occupational and Environmental Medicine, American Medical Association, American Society of Tropical Medicine and Hygiene, Physicians for Social Responsibility, Southeastern Surgical Congress, Southern Association for Oncology, Southern Clinical Neurological Society, and Wilderness Medical Society

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Steven C Dronen, MD, FAAEM  Chair, Department of Emergency Medicine, LeConte Medical Center

Steven C Dronen, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

References

  1. Wu IB, Schwartz RA. Herpetic whitlow. Cutis. Mar 2007;79(3):193-6. [Medline].

  2. Klotz RW. Herpetic whitlow: an occupational hazard. AANA J. Feb 1990;58(1):8-13. [Medline].

  3. Robayna MG, Herranz P, Rubio FA, Pena P, Pena JM, Gonzalez J, et al. Destructive herpetic whitlow in AIDS: report of three cases. Br J Dermatol. Nov 1997;137(5):812-5. [Medline].

  4. El Hachem M, Bernardi S, Giraldi L, Diociaiuti A, Palma P, Castelli-Gattinara G. Herpetic whitlow as a harbinger of pediatric HIV-1 infection. Pediatr Dermatol. Mar-Apr 2005;22(2):119-21. [Medline].

  5. Nikkels AF, Pierard GE. Treatment of mucocutaneous presentations of herpes simplex virus infections. Am J Clin Dermatol. 2002;3(7):475-87. [Medline].

  6. Cunha BA, ed. Antibiotic Essentials. 7th ed. Sudbury, Mass: Physician's Press; 2008:109.

  7. Weisman E, Troncale JA. Herpetic whitlow: a case report. J Fam Pract. Nov 1991;33(5):516, 520. [Medline].

 
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