Herpetic Whitlow Clinical Presentation

Updated: Apr 13, 2017
  • Author: Michael S Omori, MD; Chief Editor: Steven C Dronen, MD, FAAEM  more...
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Presentation

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. Considerations are as follows:

  • 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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