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A painful vegetating finger

Research output: Contribution to journalArticle

Barbara Carey, Sandeep Joshi, Kristina Semkova, Jane Setterfield

Original languageEnglish
JournalClinical and Experimental Dermatology
Early online date27 Sep 2018
Publication statusE-pub ahead of print - 27 Sep 2018


King's Authors


A 55‐year‐old woman presented with a 6‐week history of inflammation, pain and paraesthesia involving her left ring finger. The fingernail had been removed 25 days prior to presentation, based on an assumed unresponsive bacterial infection. Her medical history included pemphigus vulgaris (PV), diabetes mellitus and β‐thalassemia trait. There was circumferential inflammation, desquamation and a purulent exudate with erythema at the leading edge of the nail, suggesting an advancing lesion (Fig. 1). Intraorally, there was extensive ulceration on the dorsal tongue and a single ulcer involving the right buccal mucosa. All other skin and mucosal surfaces were unaffected. Comprehensive investigations were undertaken. Bacterial skin swab revealed a heavy growth of Citrobacter koseri. Viral swab was negative. Cortical irregularity of the proximal phalanx was noted on a radiograph, but osteomyelitis was subsequently excluded by magnetic resonance imaging. Serum ELISA studies showed levels of 6 U/mL (negative) for desmoglein (Dsg)1 and 120 U/mL (strongly positive) for Dsg3

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