Mycobacterium arupense finger osteomyelitis: Case report.

We describe a case of persistent tenosynovitis in the right fourth finger of a 50-year-old man that after almost a year of workup was found to be related to osteomyelitis caused by Mycobacterium arupense. The few cases found in the literature were associated with traumatic injuries, environmental contamination, and months of misdiagnosis. Treatment is challenging as there are limited data available on antimicrobial susceptibility and potential side effects of current therapy options.

Necrotizing fasciitis of the hand: a case report.

Necrotizing Fasciitis is a rare life-threatening infection , usually polymicrobial, that frequently affects the extremities in as many as two thirds of the cases. It typically involves primarily the muscular fascia, and then spreads through muscular and subcutaneous tissues. The early diagnosis may be challenging , and appears to be crucial in the management of this condition. We report a case of a 45-year-old man, former drug abuser, diabetic, HCV +,  who developed a necrotizing fasciitis of the hand following a minor trauma. Early diagnosis based on clinical, laboratory (LRINEC score) and radiological findings, together with an accurate debridement of the affected site, allowed us to limitate the amputation to the third ray only. The reconstruction with the capitate osteotomy and the coverage with the posterior interosseous flap helped us in further reduction of the functional impairment of the hand.

A Zone-II Flexor Tendon Injury Secondary to a Catfish Spine: A Case Report.

CASE: We present the case of a 17-year-old man who sustained a delayed rupture of a zone-II flexor tendon injury in the long finger from a catfish spine, which caused local envenomization and a likely secondary bacterial infection. He underwent surgical exploration and irrigation and debridement of the finger. The flexor digitorum profundus tendon was found to be lacerated and was primarily repaired. CONCLUSION: Catfish spines can cause traumatic disruption of anatomic structures and can envenomate the area of injury, which can lead to a secondary bacterial infection. We review the literature regarding catfish spine injuries and describe a basic treatment algorithm for patients who are injured by catfish spines.

Cutaneous Tuberculosis Occurring After a Skin Cut in a Child.

BACKGROUND: Tuberculosis is a common problem in Turkey, and cutaneous tuberculosis is a rare form of extrapulmonary tuberculosis. Herein, the authors describe a case of cutaneous tuberculosis (lupus vulgaris) occurring after contact with a sheep. CASE: A 15-year-old boy was admitted to Marmara University School of Medicine Pendik Training and Research Hospital (Istanbul, Turkey) with delayed wound healing on the left index finger and left axillary lymphadenopathy. His medical history was unremarkable except for a wound incurred when he slaughtered a sheep 3 months before. One month after this injury, the patient developed enlargement of the left axillary lymph node on the side of the wounded extremity, and the wound turned a dark black color. The biopsy specimens obtained from the wounded skin and lymph nodes showed granulomatous reaction, but acid-fast bacilli (AFB) could not be shown with Ehrlich-Ziehl Neelsen staining. The patient tested positive in an interferon-gamma release assay. Computerized tomography scans of the thorax were normal, and early morning gastric lavage specimen was negative for AFB. The wound and axillary lymphadenopathy disappeared after institution of anti-tuberculosis therapy. CONCLUSION: Tuberculosis infection must be considered in chronic skin lesions with granulomatous reaction occurring in countries with high prevalence of tuberculosis.

Predicting serious complications and high cost of treatment of tooth-knuckle injuries: a systematic literature review.

PURPOSE: The tooth-knuckle injury (TKI) is a serious and potentially costly injury seen in orthopaedic practice. The aim was to conduct a systematic literature review on the factors associated with serious complications and high treatment costs in tooth-knuckle injuries. METHODS: MEDLINE, Scopus and CINAHL were used as the literature sources. INCLUSION CRITERIA: Original research papers that reported on factors predicting serious complications and high treatment costs in TKIs were included. There were no restrictions placed on study size, language, study design or date of publication. EXCLUSION CRITERIA: Case studies, case series and review articles were not included. RESULTS: After duplicates were removed, 403 unique studies remained; after titles and abstracts were screened, 48 titles remained and were retrieved in full text. Of these, 14 titles met the inclusion criteria and were included in the data synthesis. Tenosynovitis, septic arthritis, osteomyelitis and residual stiffness were common serious complications occurring in up to 36.3, 70.0, 47.6 and 65.3 % of cases, respectively. Amputation was also common in up to 18.0 % of injuries. Treatment costs were measured by length of hospital stay and the number of debridements required. On average, patients required 3.8-8 days of admission and 1.3-2.7 debridements each. CONCLUSION: Increased time delay from injury to treatment, deeply penetrating injuries, proximal interphalangeal joint (PIPJ) injuries and, possibly, E. corrodens infections were associated with serious complications in TKIs. Delayed treatment, inadequate treatment, PIPJ injuries and deeply penetrating injuries predicted higher treatment costs. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42016029949 ( http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42016029949 ).

Pyogenic Flexor Tenosynovitis Caused by Shewanella algae.

Pyogenic flexor tenosynovitis is an orthopedic emergency most commonly caused by Staphylococcus aureus and streptococci and occasionally, when associated with water exposure, Mycobacterium marinum. Shewanella algae, a gram-negative bacillus found in warm saltwater environments, has infrequently been reported to cause serious soft tissue infections and necrosis. In this case, S. algae caused complicated flexor tenosynovitis requiring open surgical irrigation and debridement. Flexor tenosynovitis caused by S. algae rapidly presented with all 4 Kanavel cardinal signs as well as subcutaneous purulence, ischemia, and necrosis, thus meeting the requirements for Pang et al group III classification of worst prognosis. Because of its rarity and virulence, S. algae should always be considered in cases of flexor tenosynovitis associated with traumatic water exposure to treat and minimize morbidity appropriately.

Isolation of Leclercia adecarboxylata from a patient with a subungual splinter.

Leclercia adecarboxylata is a rarely described motile, aerobic, gram-negative bacillus reported to cause clinically significant solitary infections in immunocompromised patients and polymicrobial wound infections in immunocompetent patients [1-5]. We present a case of a polymicrobial infection including L. adecarboxylata in a healthy female patient with a subungual splinter, to increase awareness and aid in the diagnosis and treatment of cutaneous L. adecarboxylata infections. To our knowledge, this is the first reported case of trauma-related subungual L. adecarboxylata infection reported in the dermatology literature.

Leclercia Adecarboxylata Infection in an Immunocompetent Child.

Leclercia adecarboxylata is a motile Gram negative rod that is not often pathogenic in immunocompetent patients. We will present the first case report of a L. adecarboxylata in a pediatric patient with no systemic medical disease and present a detailed literature review.

From a fish tank injury to hospital haemodialysis: the serious consequences of drug interactions.

We present the case of a 68-year-old man admitted to hospital with severe acute kidney injury secondary to statin-induced rhabdomyolysis. Five weeks previously, the patient started a course of clarithromycin for infection of a finger wound with Mycobacterium marinum. His current medications included simvastatin, which he continued along with clarithromycin. The severity of the acute kidney injury necessitated initial continuous venovenous haemofiltration followed by 12 haemodialysis sessions before a spontaneous improvement in renal function occurred. Statins are widely prescribed and we report this case to encourage increased vigilance in avoiding drug interactions known to increase the risk of statin-induced myopathy, including macrolide antibiotics, calcium channel antagonists and amiodarone. The authors would also like to highlight recent guidance on atorvastatin as the statin of choice in patients with chronic kidney disease, and of the need for dose adjustment in those with an estimated glomerular filtration rate less than 30 mLs/min/1.73 m².

Ms. Lisa and Ms. MRSA.

Nurses aren't just healers-they're teachers, too.

Candida parapsilosis Tenosynovitis in an Immunocompetent Patient: Case Report and Review of Literature.

We describe a case of fungal tenosynovitis with Candida parapsilosis, which is an uncommonly reported agent causing tenosynovitis. It occurred in an immunocompetent individual, and the patient underwent an extensive noninfectious work-up for ongoing swelling and stiffness before being correctly diagnosed and treated. We emphasize the importance of considering atypical infections in the differential diagnoses in a patient presenting with indolent symptoms of tenosynovitis.

[Seal finger in Denmark diagnosed by PCR-technique]. / Sælfinger erhvervet i Danmark og diagnosticeret ved PCR-teknik.

Seal finger is an unusual infection in Denmark but is seen quite often in Greenland. A 69 year-old Danish man developed severe infection after cutting his finger on a sea urchin while handling a fishing net. Treatment with beta-lactam antibiotics had no effect. Standard culture from the lesion was negative. A Mycoplasma species was detected by PCR and DNA sequencing and subsequently cultured on special media. Specifically asked about exposure to sea mammals the patient could inform that a dead seal had also been trapped in the fishing net.