Photo Rounds

Swollen middle finger

A 32-year-old man sought care at a free clinic because his middle finger was swollen and painful. He indicated that he’d gotten into a fight 3 nights earlier at a bar and cut his finger on a man’s tooth while punching him in the face. In addition to unbearable pain, the patient had chills and a fever. The family physician (FP) noted erythema, swelling, and purulence of the middle finger. The finger felt warm and there was limited range of motion at the proximal interphalangeal joint.

What's your diagnosis?


The FP diagnosed cellulitis and an abscess over the proximal interphalangeal joint in this patient, a result of a closed fist bite (also known as a “fight bite”). The FP sent the patient to the emergency department for admission and inpatient care under the orthopedic service. The FP was concerned about the possibility of septic arthritis, septic tenosynovitis, and traumatic tendon injuries—in addition to the cellulitis and abscess. The flora of a human bite injury made this more risky for the patient, as well.

In the hospital, the orthopedist cultured the open wound and irrigated the joint. There were no signs of osteomyelitis, broken bones, or tooth fragments clinically or on x-rays. The patient was started on IV penicillin and vancomycin based on his weight to cover Eikenella corrodens and Staphylococcus aureus, respectively, until the culture results came back.

Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Usatine R. Cellulitis. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:693-697.

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