Indian Journal of Paediatric Dermatology

CASE REPORT
Year
: 2017  |  Volume : 18  |  Issue : 4  |  Page : 333--334

Kerion in a neonate


S Balasubramanian1, K Vindhiya2, K Dhanalakshmi1, R Ramkumar3,  
1 Department of Paediatrics, Kanchi Kamakoti Childs Trust Hospital, Childs Trust Medical Research Foundation, Chennai, Tamil Nadu, India
2 Department of Paediatrics, Sree Balaji Medical College, Chennai, Tamil Nadu, India
3 Department of Dermatology, Kanchi Kamakoti Childs Trust Hospital, Childs Trust Medical Research Foundation, Chennai, Tamil Nadu, India

Correspondence Address:
K Vindhiya
Department of Paediatrics, Sree Balaji Medical College, Chennai, Tamil Nadu
India

Abstract

Tinea capitis is predominantly an infection of children but extremely rare in neonates. Kerion is a T-cell mediated, severe pattern of an inflammatory fungal infection. It is characterized by tender, boggy nodular swelling with regional lymphadenopathy. There might be pus discharge and sinus formation that mimics bacterial folliculitis or an abscess of the scalp. Thick crusting with matting of hairs is common. Usually, area affected is limited, but multiple lesions are not rare. We report a 25-day-old neonate who presented with scalp swelling of 5 days duration. Baseline investigations were normal. Dermatological consult was obtained. Light and fluorescent microscopy along with fungal culture of the infected hair confirmed kerion due to Trichophyton mentagrophyte var. mentagrophyte. The infant was treated with griseofulvin and recovered completely.



How to cite this article:
Balasubramanian S, Vindhiya K, Dhanalakshmi K, Ramkumar R. Kerion in a neonate.Indian J Paediatr Dermatol 2017;18:333-334


How to cite this URL:
Balasubramanian S, Vindhiya K, Dhanalakshmi K, Ramkumar R. Kerion in a neonate. Indian J Paediatr Dermatol [serial online] 2017 [cited 2019 Oct 20 ];18:333-334
Available from: http://www.ijpd.in/text.asp?2017/18/4/333/206080


Full Text



 Introduction



Tinea capitis is one of the most common dermatophytes in children. It is a superficial fungal infection with a predilection for children. However, it is relatively rare in infants, especially neonates. Very few cases of neonatal kerion have been reported in literature.[1],[2],[3] The causative organism was Trichophyton species in two cases and the rest were due to Microsporum species. The earliest age was 15-day-old neonate.

 Case Report



A one-month-old female infant with uneventful birth history was noticed to have scalp swelling of 5 days duration. Baby was exclusively breastfed and gained adequate weight and was treated with oral antibiotics (amoxy-clav for 5 days) elsewhere for the above complaints with no improvement.

On examination, a localized, erythematous, boggy tender nodular swelling was noted over the vertex of scalp with loss of hair. There was exudation of pus from some of the follicular orifices [Figure 1]. Hairs were loose and easily pluckable. Matting of hair was also present. Nails and mucosa were normal.{Figure 1}

Complete blood counts were all within the normal limits. Light microscopic examination of the hair after addition of potassium hydroxide revealed small spores in the hair shaft. Fluorescent microscopy of the hair revealed features consistent with fungal infection. Culture in sabouraud dextrose agar showed rapidly growing colony with white powdery surface, which develops a creamy center. The reverse is tan or reddish brown with a paler edge [Figure 2].{Figure 2}

Baby was treated with oral griseofulvin at a dose of 20 mg/kg/day for 3 months. She recovered completely by 2 months with near normal growth of hair in the affected area.

 Discussion



Tinea capitis is a dermatophyte infection involving the scalp, which predominantly affects the hair shaft as well as the contiguous skin. Although common in infants, it is rare in neonates. There have been very few case reports of kerion in neonates.

Kerion celsi is caused most often by zoophilic dermatophytes. Microsporum canis is the most commonly associated dermatophyte. In our case, it was Trichophyton mentagrophyte var. mentagrophyte. Spread usually occurs from an infected family member or indirectly from pet animals. However, in our case, there was no obvious source of infection as history was negative for pets at home and the parents or other family members did not have any skin lesion.

Kerion might be mistaken for bacterial infections such as impetigo, folliculitis, and abscesses. Both conditions display similar clinical features such as inflammation, purulent discharge, and hair loss. Similar to our case, there are reports of kerion misdiagnosed as bacterial infection and treated with multiple antibiotics, resulting in delayed definitive diagnosis.[4],[5]

High index of suspicion is needed to diagnose. Limited knowledge, especially by nondermatologist can lead to delay in diagnosis.[1] Topical therapy is ineffective. Griseofulvin is the drug of choice. Resistant cases might require azoles and terbinafine. If left untreated, infection can spread to other areas such as face. It is also contagious and hence can affect other family members. It can lead to long-term morbidity such as scarring and alopecia.

 Conclusion



Kerion due to its close resemblance to bacterial infection is often misdiagnosed and improperly treated. The importance of appropriate treatment is essential as it leads to long-term sequelae and also unnecessary biopsies and surgical intervention in young infants.

Acknowledgment

We would like to thank Dr. Vaithegi, Consultant Microbiologist.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

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4Mazlim MB, Muthupalaniappen L. Cat's curse: A case of misdiagnosed kerion. Malays Fam Physician 2012;7:35-8.
5Feetham JE, Sargant N. Kerion celsi: A misdiagnosed scalp infection. Arch Dis Child 2016;101:503.