Atypical presentation of herpetic whitlow as dark brown vesicles in a hyperbilirubinemic patient Academic Article uri icon


  • Case presentationA 36-year old Caucasian female with a history of metastatic carcinoma of the ovary was hospitalized for a CT-guided percutaneous biliary drain placement due to compression of the bile duct by metastases causing severe hyperbilirubinemia. Upon admission the patient mentioned lesions in the left index finger that appeared 12-14 days prior to admission as small tingling reddish vesicles which subsequently grew and darkened.Physical examination was significant for severe jaundice and dark brown vesicular lesions in the left index finger without lymphangitis or lymphadenitis (Fig. 1).Fig. 1Left index finger demonstrating dark colored raised vesicular lesionsLaboratory findings were: leukocyte count = 11,200/mm3; hemoglobin = 7.2 g/dL; platelets 65,000/mm3; creatinine = 0.6 mg/dL; ALT = 170 IU/ml; AST = 157 IU/ml; total bilirubin = 14.4 IU/ml. One of the lesions was unroofed and a swab taken from the site for viral culture was reported back as HSV 1 infection. Herpetic whitl ...

publication date

  • January 1, 2014