Case report: Scald burn to the scalp complicated by fungal kerion
Theresa Nguyen,
Krist Y.H. Ewe,
Fiona Wood,
Suzanne Rea,
Asha C. Bowen
Affiliations
Theresa Nguyen
School of Medicine, University of Western Australia, 35 Stirling Highway, Perth, Western Australia 6009, Australia
Krist Y.H. Ewe
Department of Infectious Diseases, Perth Children’s Hospital, 15 Hospital Avenue, Nedlands, 6009 Western Australia, Australia; Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Northern Entrance Perth Children’s Hospital,15 Hospital Avenue, Nedlands, 6009 Western Australia, Australia; Correspondence author at: Department of Infectious Diseases, Perth Children’s Hospital 15 Hospital Avenue, Nedlands 6009, WA, Australia.
Fiona Wood
Fiona Wood Foundation, Fiona Stanley Hospital, CD15, Level 4, Burns Unit, 11 Robin Warren Drive, Murdoch, WA 6150, Australia; Burns Service of Western Australia, WA Department of Health, 11 Robin Warren Drive, Murdoch, WA 6150, Australia; Burn Injury Research Unit, School of Biomedical Sciences, University of Western Australia, 35 Stirling Highway, Perth, Western Australia 6009, Australia
Suzanne Rea
Fiona Wood Foundation, Fiona Stanley Hospital, CD15, Level 4, Burns Unit, 11 Robin Warren Drive, Murdoch, WA 6150, Australia; Burns Service of Western Australia, WA Department of Health, 11 Robin Warren Drive, Murdoch, WA 6150, Australia; Burn Injury Research Unit, School of Biomedical Sciences, University of Western Australia, 35 Stirling Highway, Perth, Western Australia 6009, Australia
Asha C. Bowen
School of Medicine, University of Western Australia, 35 Stirling Highway, Perth, Western Australia 6009, Australia; Department of Infectious Diseases, Perth Children’s Hospital, 15 Hospital Avenue, Nedlands, 6009 Western Australia, Australia; Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Northern Entrance Perth Children’s Hospital,15 Hospital Avenue, Nedlands, 6009 Western Australia, Australia; Burn Injury Research Unit, School of Biomedical Sciences, University of Western Australia, 35 Stirling Highway, Perth, Western Australia 6009, Australia; Menzies School of Health Research, Charles Darwin University, John Mathews Building (JMB), Building 58, Royal Darwin Hospital Campus, Australia
Fungal kerion is a hypersensitivity reaction to a scalp dermatophyte which gains access to the hair shaft following physical trauma. However, precipitating injuries are rarely reported. We report the case of a 4-year-old girl who presented with non-healing scalp lesions following a deep dermal forehead scald caused by hot water. The third degree burn was epithelialized with two autologous split skin grafts from a donor thigh site. The grafts were complicated by early bacterial infection treated with intravenous antibiotics. The child returned to her remote community and was lost to follow up. Three months later, fungal kerion at the same site as the burn was clinically diagnosed and confirmed with culture of Trichophyton tonsurans from plucked hair samples. Her condition improved after treatment with oral terbinafine and co-trimoxazole (for suspected bacterial co-infection). Clinical recognition of fungal kerion following a deep burn injury as a trauma mechanism is presented to facilitate early recognition in other children with similar risk factors.
