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Symptom: Painful Left Hand Swelling

Filippone, Lisa M. MD

Quick Consult

Dr. Filippone is an assistant professor of emergency medicine at Drexel University College of Medicine and the director of the Division of Emergency Ultrasound at Mercy Hospital of Philadelphia.

A 76-year-old woman presents to the ED with a swollen left hand. She said she was playing with her dog the day before when he suddenly bit her hand. It was only mildly painful and swollen when she went to bed. This morning her hand feels like it is on fire, and she cannot move it at all without severe pain.

Figure

Figure

While her entire hand hurts, the most pain is in the dorsal aspect toward the thumb. On physical exam, one can see two puncture wounds. One wound is on the thenar eminence, the other in the proximal web space between the 1st and 2nd metacarpals.

Figure

Figure

What is the likely organism causing this infection, and how should this case be managed?

© 2004 Lippincott Williams & Wilkins, Inc.