What do you suspect ? A case of a 5 yr old who comes in with a 3 mo history of an inflammatory mass on the scalp that had not responded to antibiotics. The chilsd is otherwise healthy. the arrow points to - postauricular lymphadenopathy ( and doesn't hold the clue as it is non - specific ). Rather than asking what's the diagnosis, i will ask ' what u suspect ? ' and how will you proceed ?
Everybody wins, but the first prize goes to 'Shubeto' 4 answering it completely in 2 words. This is case is Picked up from the NEJM article - Kerion Celsi Laura Erin Proudfoot, M.D., and Rachael Morris-Jones, Ph.D. N Engl J Med 2012; 366:1142March 22, 2012DOI: 10.1056/NEJMicm1104889 I will directly quote the article and highlight the imp points. A healthy 5-year-old boy presented with a 3-month history of an inflammatory mass on the scalp that had not responded to antibiotics. The physical examination revealed a boggy occipital swelling studded with pustules, as well as postauricular lymphadenopathy (arrow). The boy had no other symptoms, and the results of laboratory studies, including microbiologic swabs, were normal. A bacterial abscess was diagnosed, and he was referred for incision and drainage under general anesthesia. Before surgery, he was seen by a dermatologist who diagnosed fungal kerion, and surgery was abandoned. Subsequent scalp brushings isolated Trichophyton tonsurans. A 1-month course of oral terbinafine resulted in the successful resolution of symptoms and mycologic clearance. Kerion celsi is an inflammatory form of tinea capitis caused by a T-cell”“mediated hypersensitivity reaction to the causative dermatophyte. Early diagnosis may avert unnecessary and inappropriate surgical drainage. (-:
