A 9-year-old boy presented to the paediatric emergency with a 1-month history of erythematous lesions on the scalp, diagnosed with kerion and tinia capitis.
A 9-year-old boy presented to the paediatric emergency with a 1-month history of kerion and tinia capitis. The patient had no past medical history and the erythematous lesions on the scalp enlarged even with the use of topical antibacterials and corticosteroids.
On examination, the patient’s temperature was 38.0℃ and physical examination revealed multiple erythematous lesions and tender swellings on the scalp associated with bilateral cervical lymphadenopathy. However, there were no other significant findings on physical examination. Laboratory evaluation showed an elevated inflammatory response with a white blood cell count of 22,800 /μL (84% neutrophils) and a C-reactive protein (CRP) level of 10.99 mg/dL. There were no other abnormalities evident.
What’s remarkable is that the patient’s friend (patient 2) also developed milder scalp lesions with alopecia around the same time. Moreover, the 9-year-old would often visit his friend’s house to play with cats. For further evaluation, the hair roots were examined with potassium hydroxide wet mount which showed kinky hyphae and small spores. In addition, patient 2’s hair was positive for Microsporum canis.
The findings were consistent with the diagnosis of kerion and tinea capitis.
Both patients were prescribed itraconazole. Improvements were seen in both patients after 6 weeks of treatment. Moreover, patient 1’s hair gradually grew back.
Kerion and Tinia Capitis
Kerion is a severe inflammatory type of tinea capitis and causes a hypersensitivity reaction against dermatophytes. Tinia capitis is a scalp hair infection caused by dermatophyte fungu, Trichophyton spp. and Microsporum spp. Differential diagnosis of the condition includes tumour, bacterial cellulitis and seborrheic dermatitis. This often causes a delay in the diagnosis of tinea capitis and kerion. Moreover, for treatment, systemic antifungal therapy is needed.
References
Kerion and tinea capitis https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6031098/
