ADVANCED KERION CELSI IN A FIVE-YEAR-OLD CHILD: DIAGNOSTIC AND THERAPEUTIC CHALLENGES IN A RESOURCE-LIMITED HOSPITAL SETTING

Tinea capitis is a dermatophytic infection of the scalp, predominantly affecting pediatric populations, which may progress to severe inflammatory forms such as kerion celsi, carrying a significant risk of aesthetic and psychosocial sequelae, including permanent scarring alopecia. We report the case of a previously healthy five-year-old girl from the Itabapoana River Basin region in Brazil, who presented to local hospital facilities with fever and extensive, exudative, purulent scalp lesions. Initially diagnosed as a nonspecific bacterial infection, she received oxacillin therapy without clinical improvement of the cutaneous lesions. Subsequent evaluation at a university outpatient clinic raised clinical and epidemiological suspicion of inflammatory tinea capitis consistent with kerion celsi. In the absence of laboratory resources for specific mycological culture, empirical treatment was initiated with griseofulvin (25 mg/kg/day for 16 weeks), topical ketoconazole 2%, and a seven-day course of amoxicillin-clavulanate for secondary bacterial infection. The patient exhibited an excellent clinical response, with resolution of purulent exudate within one week and progressive regression of inflammatory lesions in the following weeks. Nevertheless, scarring alopecia developed in previously affected areas, attributable to delayed diagnosis and the intensity of the inflammatory response. This case underscores the critical importance of early recognition of inflammatory tinea capitis, particularly in settings with limited diagnostic resources, and highlights the efficacy of evidence-based empirical combination therapy when advanced diagnostic testing is unavailable.