Friday, December 31, 2004

8 yo boy with lesion on wrist

History: The patient is an 8 yo boy with a one week history of an expanding lesion on the right wrist. He plays in a sandbox that is frequented by stray cats. He's been using clotrimazole cream for three days.
Physical Exam: There is a 2 cm diameter plaque on the right wrist. The periphery appears to be vesicular and possibly a bit scaly. No other lesions.
Lab: KOH equivocal - hard to interpret because of cream artifact.
Diagnosis: ? Kerion of glabrfous skin.
I plan to stop the cream, repeat KOH in a few days and have obtained a fungal culture. Will biopsy if still uncertain and process is progressing.

Follow-up of Jan 3, 2005. The patient was seen again and the KOH prep repeated. Today, this was markedly positive (no cream artifact) Dx: Kerion of Glabrous Skin. Usually caused by M. canis. See below for references.


2.5 cm lesion right wrist Posted by Hello

References:
1: Alteras I, Feuerman EJ, David M, Segal R.
The increasing role of Microsporum canis in the variety of dermatophytic
manifestations reported from Israel.
Mycopathologia. 1986 Aug;95(2):105-7.
PMID: 3762660 [PubMed - indexed for MEDLINE]

2: Powell FC, Muller SA.
Kerion of the glabrous skin.
J Am Acad Dermatol. 1982 Oct;7(4):490-4.
PMID: 6216270 [PubMed - indexed for MEDLINE]
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1 comment:

  1. Humane Medicine HuiJanuary 06, 2005

    Classical case of zoophilic dermatophytosis. I would treat it with oral terbinafine. 1 week dosage would be sufficient.

    ReplyDelete

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