Kerion

An eight-year-old boy presented with a 5 x 6 cm erythematous, boggy mass with purulent discharge and alopecia on his scalp, initially misdiagnosed and treated unsuccessfully with antibiotics and ketoconazole cream. The lesion, which began as a patch of hair loss and progressed despite treatment, was accompanied by ipsilateral cervical lymphadenopathy and similar skin lesions on the patient and his father, with their pet cat also showing bald patches. A potassium hydroxide preparation of skin scrapings revealed fungal hyphae, leading to a diagnosis of kerion, an inflammatory tinea capitis. The boy was successfully treated with oral griseofulvin (20 mg/kg daily) for 12 weeks, and after four weeks, Trichophyton tonsurans was isolated from the culture. The case highlights the importance of recognizing kerion to avoid inappropriate treatments and the potential for permanent hair loss, with systemic antifungal treatment being necessary for tinea capitis. The source of the infection was unclear, though the family cat was suspected and treated.