eMedicine Specialties > Emergency Medicine > Infectious Diseases

Herpetic Whitlow: Differential Diagnoses & Workup

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
Contributor Information and Disclosures

Updated: May 27, 2009

Differential Diagnoses

Cellulitis
Felon
Paronychia

Workup

Laboratory Studies

  • Diagnosis of herpetic whitlow usually is clinical, based on presentation of the affected digit with characteristic lesions and a typical history.
  • In children, observation of concurrent gingivostomatitis is almost pathognomonic.
  • In adults, the presence of occupational risk factors or finding of concurrent oral or genital herpes lesions should strongly suggest the diagnosis.
  • Definitive diagnostic testing includes the Tzanck test, viral cultures, serum antibody titers, fluorescent antibody testing, or DNA hybridization.
    • In the Tzanck test, smears are obtained by scraping the base of an unroofed vesicle. Smears are Giemsa stained, and a positive test is indicated by light microscopy findings of multinucleated giant cells, often with visible viral inclusions.
    • Viral culture of the aspirated vesicle fluid is the most sensitive assay, but this test is usually more costly and time consuming, requiring 24-48 hours.
    • Serum antibody titers are usually cost prohibitive, as are fluorescent antibody testing and DNA hybridization, which are not commonly available.
  • Recurrent infections, atypical presentations, or unusual locations should suggest an immunodeficient state. HIV testing should be considered in patients with such presentations.3,4

More on Herpetic Whitlow

Overview: Herpetic Whitlow
Differential Diagnoses & Workup: Herpetic Whitlow
Treatment & Medication: Herpetic Whitlow
Follow-up: Herpetic Whitlow
References
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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. Weisman E, Troncale JA. Herpetic whitlow: a case report. J Fam Pract. Nov 1991;33(5):516, 520. [Medline].

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Further Reading

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Keywords

herpetic whitlow, herpetic infection, hand infection, herpes simplex virus, HSV-1, herpes simplex virus 2, HSV-2, infection of the hand, infection of the finger

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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.

Medical Editor

Robin R Hemphill, MD, MPH, Associate Professor, Director, Disaster Preparedness, Department of Emergency Medicine, Vanderbilt University Medical Center
Robin R Hemphill, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Eric L Weiss, MD, DTM&H, Director of Stanford Travel Medicine, Medical Director of Stanford Lifeflight, Assistant Professor, Departments of Emergency Medicine and Infectious Diseases, Stanford University School of Medicine
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.

CME Editor

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, Director of Emergency Services, Director of Chest Pain Center, Department of Emergency Medicine, Ft Sanders Sevier 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.

 
 
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