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A 14-year-old female adolescent presents with a small red spot on her scalp
Clinical VignetteA clinical vignette is a concise presentation of an interesting or challenging patient encounter that stimulated an interesting learning issue.
Case Study 6: Scalp swelling with purulent discharge -
10-07-2006, 09:11 AM
A 14-year-old female adolescent presents with a small red spot on her scalp. Her primary care physician advises her to use an antidandruff shampoo. Over the next 6 days, the lesion increases in size and becomes tender. The family notes that the lesion is crusted and occasionally oozes thick material.
The patient is systemically ill with a fever and poor appetite. Her primary care physician diagnoses a bacterial abscess of the scalp, institutes therapy with oral dicloxacillin, and requests a consultation with a surgeon for incision and drainage. What is the diagnosis?
Hint:The patient's parents are dairy farmers. Presently, the cows are experiencing an outbreak of a skin disease.
Oak is correct! this is a case of Tenia capitis infection:
Kerion (tinea capitis): A kerion is an inflammatory response, likely an allergic reaction, to tinea capitis. Clinically, kerions are boggy and tender scalp swellings associated with hair loss and purulent drainage. Trichophyton and Microsporum species are the most common fungi that cause tinea capitis. In more than 90% of cases, tinea capitis is spread between people who share brushes, combs, barrettes, hats, or pillows; fewer than 10% of cases are transmitted from infected animals. In this patient, Trichophyton verrucosum from the dairy cows was isolated.
Therapy for a kerion includes the use of oral antifungal agents, systemic steroids, and antidandruff shampoo. The antifungal of choice is griseofulvin ultramicrosize 7.3 mg/kg/d administered orally for 6-8 weeks. When taken with fatty foods, griseofulvin is absorbed effectively. Systemic steroids decrease inflammation and hasten recovery. Antidandruff shampoo decreases the transmission of tinea capitis between persons in close contact. Surgical drainage is contraindicated.
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