A 45-year-old alcoholic male presents with fevers and right-hand pain. He cannot recall what happened but thinks he may have punched someone in the face in a bar fight two nights earlier. He has tried over-the-counter anti-inflammatory agents, but they have not helped decrease the pain. His temperature is 100.8 °F, blood pressure is 132/88 mmHg, and pulse is 78/min. On physical exam, he has a skin break over his second phalanx-metacarpal region. He is holding his second finger in slight flexion. He has a sausage-shaped swelling of the finger, as well as flexor tendon sheath tenderness that extends the entire length of the tendon. His pain increases with passive motion of the finger.

Which is the most likely diagnosis?

Option 1: Suppurative tenosynovitis due to Eikenella corrodens
Option 2: Gout
Option 3: Dupuytren's contracture
Option 4: Suppurative tenosynovitis due to Pasteurella multocida
Option 5: Felon

The patient's symptoms are suggestive of suppurative tenosynovitis due to Eikenella corrodens, a condition which involves infection of the tendon sheath. This diagnosis is highly probable given the patient's history of potential exposure to human oral flora during a fight.

Explanation:

The scenario is suggestive of a condition called suppurative tenosynovitis, which is an infection of the sheath surrounding a tendon. Given that the person mentioned may have been involved in a fight, the infection could be due to a bacterial organism. The bacteria could easily have entered his system through the skin break in the second phalanx-metacarpal region.

However, it is crucial to identify the potential causative organism. While both Eikenella corrodens and Pasteurella multocida could cause this type of infection, the latter is more associated with animal bites rather than human injuries. Therefore, Option 1: Suppurative tenosynovitis due to Eikenella corrodens seems more plausible in this scenario, provided no animal contact was involved.

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