Herpetic whitlow is an acute viral infection of the hand caused by either herpes 
simplex virus (HSV) 1 or 2. Its characteristic findings are significant pain and 
erythema with overlying nonpurulent vesicles. The differential diagnosis 
includes flexor tenosynovitis. We present a case of recurrent infection of the 
middle finger in an immunocompetent 19-year-old girl. Multiple painful pustules 
with tracking cellulitis were partially treated by oral antibiotics. A 
recurrence with positive Kanavel's signs suggested flexor tenosynovitis at seven 
months. Her symptoms improved transiently following emergent surgical open 
flexor sheath exploration and washout however, she required two further 
washouts; at eleven and thirteen months to improve symptoms. Viral cultures were 
obtained from the third washout as HSV infection was disclosed from further 
history taking. These were positive for HSV2. Treatment with acyclovir at 
thirteen months after presentation led to a complete resolution of her symptoms 
with no further recurrences to date. This rare case highlights the similarity in 
presentation between flexor sheath infection and herpetic whitlow which can lead 
to diagnostic confusion and mismanagement. We emphasise the importance of 
careful past medical history taking as well as considering herpetic whitlow as a 
differential diagnosis despite the presence of strongly positive Kanavel's 
signs.