title: Recurrent primary paediatric herpetic whitlow of the big toe.
abstract: A 9-month-old baby girl presented multiple times with an erythematous, papular and pustular big toe in an otherwise healthy infant. A diagnosis of cellulitis was made and she was started on oral antibiotics, and bacterial swabs were taken. After 2 weeks of worsening appearance she was admitted for intravenous antibiotics. Inflammatory markers remained normal and viral swabs were taken. No improvement was seen after 2 days and she was referred for orthopaedic and dermatological opinions. The orthopaedic team recommended debridement whereas the dermatologist suspected a primary herpetic whitlow and recommended intravenous acyclovir in addition to intravenous antibiotics. A viral swab for Herpes simplex virus type 1 (HSV1) was positive by PCR on day 3. The toe continued to improve clinically and the patient received 21 days of acyclovir in total. 27 days after discharge the infection relapsed. She was treated with a further 14 days of oral acyclovir and recovered completely.
authors: Department of Paediatrics,  Southport and Ormskirk NHS, Ormskirk,  UK.
authors: Alexander P
authors: AP
authors: Murphy
authors: Premkumar
authors: P
authors: Martin
authors: Cecilia M
authors: CM
authors: Jukka
authors: Aamir
authors: A
authors: Memon
authors: Sze May
authors: SM
authors: Ng
mesh_terms: D000212:Acyclovir / Q000008:administration & dosage; D000284:Administration, Oral; D000998:Antiviral Agents / Q000008:administration & dosage; D004279:DNA, Viral / Q000032:analysis; D003937:Diagnosis, Differential; D005260:Female; D005533:Foot Dermatoses / Q000175:diagnosis* / Q000188:drug therapy / Q000821:virology; D006561:Herpes Simplex / Q000175:diagnosis* / Q000188:drug therapy / Q000821:virology; D018259:Herpesvirus 1, Human / Q000235:genetics; D006801:Humans; D007223:Infant; D016133:Polymerase Chain Reaction; D012008:Recurrence; D014034:Toes
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D000212:Acyclovir