The diagnosis
The patient had herpetic whitlow—a herpes simplex virus (HSV) infection of the finger. Other conditions that could look like this include paronychia (infection of the nail fold) from a bacterial infection, or a felon, which is a bacterial infection of the pulp of the distal finger.
Herpetic whitlow used to be a common infection among dental hygienists. Now the use of gloves and universal precautions has made this less likely. Our patient had no idea where she picked up this infection, but was eager to receive treatment.
The physician pierced the pustule with a #11 blade and cultures were sent for bacteria and HSV. The patient was started on acyclovir since her physician felt HSV was the most likely cause of the infection. She had pain relief within a day and the lesion was fully clear in 2 weeks.
This case was adapted from: Mayeaux EJ. Herpes simplex. In: Usatine R, Smith M, Mayeaux EJ, Chumley H, Tysinger J, eds. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:513-517.
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