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?
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I put together these medical challenges. The cases are hypothetical and do not necessarily represent actual or typical presentations of medical diseases. Disclaimer is at the bottom of this page.
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2 comments:
painting someone's mouth?
hehehe yes, it was a "fight bite"
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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.
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