The location (perionychium) and rapid onset (4 days) of this patientıs infection is consistent with an acute paronychia. Generally, bacterial infections are more acute, and fungal infections are chronic. Thumb-sucking is a common cause for such infections. This presentation is unlikely to be a felon because felons cause severe pain and develop in the pads of the fingers and near the distal interphalangeal joints. Herpetic whitlow, caused by a herpes simplex virus, causes pain and swelling and leaves small clear vesicles or cysts. A tumor is unlikely because of the location of infection and age of the child.5
- Bacterial paronychia.
5. Jebson PJ. Infections of the fingertip. Paronychias and felons. Hand Clin 1998;14:547-55.
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