The Painful Purple Digit: An Alarming Complication of Candida albicans Antigen Treatment of Recalcitrant Warts

Marissa Perman; J. Barton Sterling; Anthony Gaspari

Disclosures

Dermatitis. 2005;16(1):38-40. 

In This Article

Case Report

A 20-year-old female presented for follow-up of recalcitrant periungual warts. After unsuccessful traditional wart treatments, including salicylic acid in flexible collodion (Duofilm, Stiefel Laboratories, Coral Gables, FL), liquid nitrogen, imiquimod (Aldara, 3M, St. Paul, MN), trichloroacetic acid, bichloroacetic acid, and bleomycin, the patient was offered a trial of CA antigen (Bayer, Spokane, WA). The patient appropriately responded to an initial trial of 0.2 cc of CA antigen solution for delayed-type hypersensitivity testing with 25 mm of induration. One month later, 0.1 cc (1:10 dilution) of CA antigen solution was injected intradermally to each periungual wart on the patient's left thumb and index finger. At her 1-month follow-up appointment, the patient reported ongoing inflammation and tenderness in both digits. At that time, there was no evidence of residual warts. However, the patient returned 3 months later, complaining of the recurrence of warts, and a verrucous lesion on each fingertip was noted. The patient was then treated with another intradermal injection of Candida antigen solution (at the same dose as before) into the left thumb and index finger. Within 24 hours, the patient reported distal pain, swelling, and a purple hue to only the index finger (fig1). We became concerned with the possible complication of hematoma or compartment syndrome of the digit. The patient was sent for Doppler studies, which showed positive pulses in the digit. The patient was then referred to plastic surgery, and the distal digit was incised to rule out a hematoma. However, no hematoma was found at the time of surgery. The swelling resolved during the next few days, and the patient healed without further complication.

Left distal index finger showing erythema, edema, and purple hue 24 hours after a second injection of CA antigen.

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