Friday, August 28, 2009

Pacman

A 25 year old gang member presents to the emergency department with a 1cm laceration over the third and fourth metacarpophalangeal joint of his right hand. He is right handed. When you ask him how he got this injury, he says "Uh, well, um, I was working on my house, and uh, I got cut while painting. Yeah, painting." The exam shows tenderness, erythema, swelling, purulent drainage, lymphangitis, and low grade fever. Four separate isolates are cultured out of the wound, both aerobic and anaerobic bacteria.

Challenge: How did he get this wound?

3 comments:

Stephanie said...

he punched a sucker in the mouth!

Alex said...

painting someone's mouth?

Craig Chen said...

hehehe yes, it was a "fight bite"
-
Pacman

This is a human bite injury; the patient likely punched someone in the mouth. The bacteriology includes aerobic (streptococci, S. aureus, Eikenella corrodens) and anaerobic (Fusobacterium, Peptostreptococcus, Prevotella, Porphyromonas) bacteria. Because of proximity to the joint space, there is a high risk of deep soft tissue infection, septic arthritis, and osteomyelitis. Treatment is surgical exploration, antibiotics, and tetanus shot.

Source: UpToDate.