An operating room employee with a necrotic fingertip.

Abstract

Vital parameters of patient A at first presentation were within the normal range: temperature 37.9 C, blood pressure 121/78mm Hg and pulse rate 90 bpm. The results for laboratory tests performed on admission were notable for a white blood cell (WBC) count of 18.4 10 cells l 1 (reference, 2.5–8.2 10 cells l ) with 90.9% neutrophils, and a CRP of 86mg l 1 (reference, <10mg l ). Physical examination revealed a swollen and necrotic fingertip of the left index finger (Fig. 1a). Flexion was limited, and palpation of the tendon at the mid phalanx was painful. Examination of the left arm revealed lymphangitis on the dorsoradial side of the underand upper arm, reaching up to the left axilla (Fig. 1b). Intravenous treatment with benzylpenicillin and clindamycin was initiated. Exploration of the index finger by incision revealed transparent serous fluid but no pus. A sample was obtained for Gram staining and culture.