BACKGROUND Herpetic whitlow is a viral infection caused by the herpes simplex virus (HSV) types 1 or 2, and occurs in the pediatric population primarily on the fingers and toes due to autoinoculation from oral secretions. Because of this cited prevalence, other locations of herpetic whitlow may go unrecognized. CASE PRESENTATION We present an atypical presentation of palmar herpetic whitlow with delayed recognition and associated viral lymphangitis. The patient presented as a transfer from an outside hospital with a progressive, three-day history of a suspected left hand abscess preceded by left hand pain and itching. She was initially evaluated by Orthopedic Surgery, who described an erythematous, edematous, tender, left palmar abscess with associated erythematous streaking up her forearm. The lesion was surgically managed with an incision and drainage. Wound cultures were obtained during which "minimal drainage" was noted. After admission to the General Pediatrics Hospital service, the lesion was noted to appear vesicular and subsequently obtained PCR samples were positive for HSV type 1, confirming her diagnosis of herpetic whitlow. Although she remained afebrile with negative wound cultures throughout her hospitalization, a secondary bacterial infection could not be conclusively excluded due to the accompanying lymphangitis. Thus, she was discharged with oral antibiotics and anticipatory guidance of potential recurrence of palmar lesions. CONCLUSIONS Herpetic whitlow should be included in the differential diagnosis of palmar lesions that appear vesicular or abscess-like to ensure appropriate treatment. Additionally, these palmar lesions may present with associated lymphangitis without evidence of bacterial infection.

中文翻译：

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病例报告：一名10岁女性手掌带状疱疹和前臂淋巴管炎。

背景技术疱疹性疱疹是由1型或2型单纯疱疹病毒（HSV）引起的病毒感染，并且由于自口腔分泌物的自动接种而在儿科人群中主要发生在手指和脚趾上。由于这种引用的患病率，带状疱疹的其他部位可能无法识别。病例介绍我们提出了一种非典型性的手掌疱疹性角化病，伴有延迟识别和相关的病毒性淋巴管炎。该患者表现为从外部医院转移过来，具有可疑的左手脓肿的三天进行性病史，然后出现左手疼痛和瘙痒。最初由骨外科评估，该患者描述了红斑，水肿，触痛，左手掌脓肿，伴有前臂红斑。通过切口和引流术对病变进行手术处理。获得伤口培养物，在此期间注意到“最小引流”。进入普通儿科医院服务后，发现该病灶呈水疱状，随后获得的PCR样本对1型HSV呈阳性，证实了她对疱疹性黄疸的诊断。尽管在住院期间她一直保持发热，伤口培养阴性，但是由于伴随的淋巴管炎，不能最终排除继发性细菌感染。因此，她出院时口服抗生素并预期到了手掌病变潜在复发的指导。结论疱疹性黄疸应包括在手掌出现囊泡或脓肿样病变的鉴别诊断中，以确保适当的治疗。此外，