A red, swollen and painful lesion on the right hand after local steroid injections
2 Department of Surgery, Division of Plastic Surgery, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan
3 Department of Pathology, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi; Department of Cosmetic Science, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
No. 539, Zhongxiao Road, East District, Chiayi 600
|How to cite this article:
Liao K, Fang C, Chen C. A red, swollen and painful lesion on the right hand after local steroid injections. Indian J Dermatol Venereol Leprol 2018;84:54-56
A 60-year-old woman with a history of trigger finger presented with a 2-week history of a swollen right middle finger. She had received local steroid injections twice for trigger finger 1 month before the visit. Unfortunately, the injection site became red, swollen and painful [Figure 1a]. No evidence of immunosuppression was proven by tests for human immunodeficiency virus, hepatitis B virus, hepatitis C virus and diabetes. She subsequently underwent local debridement. On incision, there was serosanguinous discharge and necrotic synovitis of the volar side of the right third metacarpal head region [Figure 1b]. Histopathological examination revealed numerous spore-like microorganisms in the necrotic debris [Figure - 2]. Numerous endospores with occasional floret-like arrangement were identified on periodic acid-Schiff and silver stains [Figure - 3]. Tissue cultures were set up on blood agar plate and Sabouraud dextrose agar. The wet mount revealed round-to-oval spores of varying sizes (about 10–20 μ) with varying number of endospores inside.
|Figure 1a: The right hand showed local redness and inflammation|
|Figure 1b: On surgical exploration necrosis was observed|
|Figure 2: Spore-like microorganisms were found in necrotic debris (H and E, ×400)|
|Figure 3: The Periodic acid-Schiff stain revealed numerous spore-like microorganisms (×400). The endospores with typical floret-like arrangement are identified (inset)|
What is the diagnosis?
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