Pediatric flexor tenosynovitis and impetigo: an unusual association?

Abstract

We describe the case of a child with impetigo in a typical facial distribution who went on to develop flexor tenosynovitis of the hand. The isolated organisms from cultures taken from the face and peri-operatively from the hand were the same (group A beta haemolytic Streptococcus), leading us to believe that there is an association between the conditions in our patient. Impetigo is a common childhood infection typically affecting the peri-oral region. The commonest pathogens are Streptococcus and Staphylococcus (Bernard, Curr Opin Infect Dis 21(2):122–128, 2008). Flexor tenosynovitis most frequently occurs after a breach in the skin on the volar aspect of the affected finger, permitting entry of organisms. If left untreated, this condition can result in significant destruction of the flexor mechanism and subsequent disability of the hand. Our patient made a good recovery following irrigation of the flexor sheath, intravenous antibiotics, and early post-operative physiotherapy. The association between impetigo and flexor tenosynovitis has not been previously made in the literature, and the clinical correlation is important in order to provide prompt and appropriate specialist treatment.