Infectious Diseases in Children, November 2017
James H Brien, DO
Over the last 1 to 2 days, a 3-year-old female experienced a sudden onset of poor oral intake accompanied by blistering lesions on several of her fingers. By the next day, essentially all of the patient’s fingertips had become swollen and erythematous (Figure 1).
The patient then presented to her primary care physician, who diagnosed her with multiple paronychia and prescribed Keflex (cephalexin, Pragma Pharmaceuticals) and topical mupirocin. According to the mother, the child could not tolerate the medicine because of pain in her mouth, and returned 2 days later with more finger pain and some sores in and about the mouth. She was given a shot of intramuscular ceftriaxone and a prescription for oral amoxicillin. However, the amoxicillin could not be tolerated — again because of mouth pain — and after outpatient management failed, she was admitted to the hospital.