Spot Diagnosis

An Unexpected Complication of Gingivostomatitis

Marina Mota1, António Sampaio Mesquita2, Maria do Rosário Stilwell3, Cláudia Silva3, Florbela Cunha2
1Department of Pediatrics, Hospital Santa Maria - Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal, 2Department of Pediatrics, Hospital Vila Franca de Xira, Vila Franca de Xira, Portugal, 3Department of Pediatrics, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal

Address for Correspondence: Hospital Santa Maria, CHULN, Av. Professor Egas Moniz, 1649-035 LISBON, Portugal
Keywords : Gingivostomatitis, herpetic whitlow, herpes simplex virus type 1
Question :
A 2-year-old healthy boy presented to the Emergency Department with 3 days of high fever and poor feeding. Physical examination showed gingivostomatitis. Routine investigations didn’t show any abnormality. Due to anorexia and mild dehydration, he was admitted for rehydration. The following day, localized swelling, redness, and tenderness were noted on the second right finger. Bacterial paronychia was considered and intravenous flucloxacillin was started. During hospitalization, it was noted that the child sucked his fingers often. The lesion became larger and vesiculobullous (Figure 1). Surgical incision was performed with drainage of serous fluid.

Figure 1. Swelling, redness, and a large vesiculobullous lesion on the second right finger.
<b>Figure 1.</b> Swelling, redness, and a large vesiculobullous lesion on the second right finger.

What is the diagnosis?
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