Diagnostic Considerations

Blunt trauma to the fingertip may mimic a felon, but the history should suggest the correct diagnosis. Herpetic whitlow may cause fingertip pain, but it is not typically erythematous or tensely swollen, in addition vesicles should be presents. Orf infections may be mistaken for a felon however these are generally painless and have clear drainage.^[4]A pyogenic tenosynovitis may also mimic a felon. A paronychia may cause pain, erythema, and swelling, but the tenderness and swelling are typically greater on the extensor side of the digit. A paronychia may progress to a felon. If the swelling and pain spread to the DIP joint or proximally, consideration for tenosynovitis or a septic joint should be made.

Differential Diagnoses

Workup

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Media Gallery

Differential diagnosis for a felon includes herpetic whitlow.
A paronychia can progress to a felon if left untreated.
Drainage of pus from under perionychium in a paronychia.

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Author

Brandon Stein, MD Medical Student Clerkship Director, Core Faculty, Department of Emergency Medicine, Kendall Regional Medical Center

Brandon Stein, MD is a member of the following medical societies: American College of Emergency Physicians, Emergency Medicine Residents' Association, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

Jon Mark Hirshon, MD, MPH, PhD, FACEP Professor, Department of Emergency Medicine, Professor, Department of Epidemiology and Public Health, University of Maryland School of Medicine; Chief, Emergency Department, Baltimore VA Medical Center

Jon Mark Hirshon, MD, MPH, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Public Health Association, 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, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Additional Contributors

Jeffrey Glenn Bowman, MD, MS Consulting Staff, Highfield MRI

Disclosure: Nothing to disclose.

Mary Catherine Bowman, MD, PhD Program Director, Infectious Diseases Fellowship Program, Orlando Health; Clinical Assistant Professor, University of Central Florida College of Medicine and Florida State University College of Medicine

Mary Catherine Bowman, MD, PhD is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Jarod Fox, MD Fellow in Infectious Diseases, Orlando Health

Jarod Fox, MD is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America, International Society for Infectious Diseases

Disclosure: Nothing to disclose.

Acknowledgements

Glen Vaughn, MD Director, Department of Emergency Medicine, Defiance Hospital

Disclosure: Nothing to disclose.