Images in Emergency Medicine

Article Outline

• Diagnosis
  • Digital septic emboli
• Copyright

A 19-year-old previously healthy man complained of a sore throat for 5 days, accompanied by fever and chills. He then developed pain and swelling in his left knee and thigh. On the day before his presentation, he noticed pain and discoloration of 2 fingertips on his right hand. Our evaluation revealed a tense and indurated left thigh and knee. A large pustule was present on his left index finger pad, with small lesions at the base (Figure 1). His right middle and ring finger pads had areas of frank necrosis (Figure 2). He was taken to the operating room for drainage and irrigation of his knee, fasciotomies of his thigh, and debridement of his fingers.

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• Figure 1. 

  Left hand index finger with large pustules on the finger pad and the second pustule at the metacarpal base.

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• Figure 2. 

  Right hand middle and ring finger with areas of necrosis. Used with permission of Joseph Shiber, MD, Brody School of Medicine, East Carolina University, Greenville, NC.

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Diagnosis 

Digital septic emboli 

Cultures from his throat, blood, knee synovial fluid, fascia, and fingers all returned β-hemolytic group A streptococcus, identified as Streptococcus pyogenes. He was treated with intravenous penicillin and serial debridements of his thigh; after 1 month he was fully recovered.