Giant kerion of Celsus in a pediatric patient. Case report
Keywords:
Kerion of Celsus; Tinea capitis; Trichophyton tonsurans; Pediatrics; TerbinafineAbstract
Introduction: Kerion of Celsus is a severe inflammatory form of tinea capitis, uncommon in pediatrics, which presents a diagnostic and therapeutic challenge. Its presentation as a giant lesion is exceptional.
Objective: To report a clinical case of giant kerion of Celsus in a pediatric patient and its multimodal management.
Case presentation: A 7-year-old female patient, with no relevant medical history, presented with a scalp lesion of 15 days' duration that did not respond to amoxicillin. Physical examination revealed a 12 x 10 cm reddish-purple tumor-like plaque in the central region, with short, brittle hairs, multiple confluent pustules draining seropurulent exudate (honeycomb sign), painful to palpation, and with inflammatory lymphadenopathy. Direct examination with KOH was positive, and mycological culture identified Trichophyton tonsurans. Treatment was initiated with terbinafine (125 mg/day for 8 weeks), prednisone (25 mg/day with gradual tapering), and cotrimoxazole (12.5 mL every 12 hours for 7 days). The outcome was favorable, with complete resolution, no adverse effects, normal liver enzymes, and full hair regrowth within three months.
Conclusions: Giant kerion of Celsus caused by Trichophyton tonsurans requires early diagnosis and aggressive multimodal treatment. Triple therapy (antifungal + corticosteroid + antibiotic) proved effective and safe, achieving clinical resolution and preventing scarring alopecia. This case has significant educational value.
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