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A 17-month-old boy presented to the Emergency Department (ED) with a minor laceration
on the distal portion of his fifth digit, which was sutured and placed in a splint
for protection. Two days later, the patient removed the splint himself while playing.
His parents noticed a small blister on his thumb and returned to the ED that day.
In the ED, the thumb had minor blistering with surrounding erythema. He was afebrile
and had an otherwise normal examination. The splint was replaced and he was started
on amoxicillin for presumed skin infection. The next morning, 3 days after the initial
laceration repair and splinting, the parents were concerned that the child was in
pain and his fingers were noticeably swollen. In the ED, the child was irritable but
consolable by his parents, and his vital signs were appropriate for his age. The splint
was removed, revealing multiple large bullae on his right hand (Figure 1, Figure 2, Figure 3). His hand was tender to palpation and his fingers had decreased range of motion
but adequate capillary refill.
Figure 1Generalized edema and erythema of the right hand and digits with a 5-cm tense, serous
bullae on the dorsal aspect of the thumb. Pen marks the previous border of erythema.
