Actinomycosis of the hand: A case report

Abstract

Actinomyces israelii is a commensal organism of the oral cavity. When introduced into a microaerophilic environment in the deeper tissues of the body, it can produce a chronic suppurative infection which is difficult to eradicate. Actinomycosis can follow any human bite which penetrates the skin. We present such a case occurring in the hand. Case report A 31-year-old black male plasterer was examined on Sep­ tember I, 1978, for a swollen left hand. On February 14, 61h months previously, he had been involved in a fight in which he struck a man in the mouth with a closed left fist. Immedi­ ately after the fight he noticed teeth marks and a superficial abrasion over the head of the left second metacarpal. The abrasion healed rapidly, but 4 days later the area began to swell, and the swelling persisted. There was minimal pain and tenderness, and the swelling did not interfere with the normal use of his hand. He was right handed and an otherwise fit man. Initial examination revealed moderate swelling of the left hand in the region of the second metacarpal and extending into the first interosseous space. There was mild tenderness only and otherwise the hand was normal. He was afebrile, and no lymphadenopathy in the relevant lymph drainage areas was detected. Radiological examination of the cut hand with routine views showed erosion of bone on the radial side of the neck of the second metacarpal. A Brewerton view markedly im­ proved the delineation of the extent of bone erosion (Fig. 1). This is in keeping with other reports on the use of the Brewer­ ton view in detecting changes in the metacarpal head and bone.t. 2