Painful Swelling of the Finger

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Abstract
A 22-YEAR-OLD pediatric nurse suddenly developed severe pain and swelling of the distal portion of the right index finger (Fig 1). This appeared to have its origin at the site of a superficial abrasion acquired four days before while cleaning some instruments in a pediatric nursery. Multiple deep vesicles and pustules rapidly appeared on a broad erythematous base. The most striking feature was the pain, which required narcotics for relief. Regional axillary nodes were enlarged and tender. Her temperature was 100.6 F (38.1 C). The white blood cell count was diminished to 2,300 cells per cubic millimeter with a normal differential. A smear of the cells at the base of a vesicle (Tzanck Test) shows intranuclear inclusion bodies (Fig 2). Bacterial and fungal cultures were negative. The finding of inclusion bodies on the Tzanck smear establishes the viral etiology of the lesion. Further questioning uncovers the fact that some of

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