Kerion celsi: case report on an infant

Abstract

Introduction: Tinea capitis is caused by dermatophyte fungi that affects the scalp and hair, occurring predominantly in childhood. Its clinical presentation is variable and depends on the hosts resistance and inflammatory response. The most severe pattern of manifestation is Kerion celsi, a suppurative inflammation of the scalp. Objective: To describe and raise awareness about the importance of an early and accurate diagnosis of Kerion celsi, differentiating it from bacterial infections, as a late treatment of that lesion can lead to cicatricial alopecia. Case description: Female patient, 1 year and 11 months, was referred to a tertiary hospital presenting scalp suppurative lesion, associated with alopecia. A previous attempt of treatment with oral antibiotics and topical corticosteroids showed no improvement. After evaluation, the hospitals service of pediatric dermatology considered the hypothesis of Kerion celsi. A superficial scraping of the lesion was gathered for culture samples and the treatment with griseofulvin 20 mg/kg was initiated. After 15 days, Microsporum canis was isolated from the fungal culture, supporting the maintenance of treatment with griseofulvin. By the end of the treatment, the patient presented improvement of the lesions and slight hair growth. Discussion: Despite Tinea capitis being a common occurrence in childhood, its most severe manifestation, named Kerion celsi, is not well known, being frequently mistaken for a bacterial infection. An early recognition of the lesion and suspicion to diagnosis are essential for the treatment to be carried out correctly and permanent damage to be avoided.