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 during 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.

What is the most likely diagnosis?

A. Suppurative tenosynovitis due to Eikenella corrodens
B. Gout
C. Dupuytren's contracture
D. Suppurative tenosynovitis due to Pasteurella multocida
E. Felon

A 45-year-old male with fever, hand pain, and specific signs of infection likely has suppurative tenosynovitis due to Eikenella corrodens, commonly associated with human bites and injuries like those sustained in a bar fight.The correct option is A.

Explanation:

The most likely diagnosis for the patient presenting with fever, right-hand pain, and certain physical findings after a potential injury from a punch is suppurative tenosynovitis.

Suppurative tenosynovitis is a bacterial infection within the tendon sheath that typically arises from trauma, such as a human bite or a penetrating injury, leading to the introduction of bacteria.

The symptoms described, including the skin break over the phalanx-metacarpal region, sausage-shaped swelling, flexor tendon sheath tenderness, and increased pain with passive motion, are highly indicative of this condition.

Eikenella corrodens is a bacterium commonly found in human oral flora and is often responsible for infection after a human bite, therefore, (A) Suppurative tenosynovitis due to Eikenella corrodens is the most likely diagnosis given the patient's history of a recent bar fight where he may have punched someone in the face.The correct option is A