'Punch' actinomycosis causing osteomyelitis of the hand.
Osseous actinomycosis usually results from direct invasion of bone from adjacent soft-tissue infection. Involvement of the jaw and vertebral column has been frequently reported, but involvement of the bones of the wrist or hand is rare. A patient with osteomyelitis of the distal right first metacarpal bone due to Actinomyces israelii following a punch injury during fisticuffs is described. Review of similar cases revealed a striking association of this type of infection with punch injuries; hence the term, punch actinomycosis. Analysis of the pus in these infections typically reveals sulfur granules; strict anaerobic conditions must be employed to culture the etiologic agent, A israelii. Management of individual cases should include surgical débridement combined with high-dose parenteral penicillin, followed by long-term penicillin therapy, orally.
Blinkhorn
R J
RJ
Department of Medicine, Case Western Reserve University, Cleveland Metropolitan General Hospital 44109.
Strimbu
V
V
Effron
D
D
Spagnuolo
P J
PJ
D000196:Actinomycosis / Q000209:etiology* / Q000628:therapy; D003646:Debridement; D006801:Humans; D008297:Male; D008663:Metacarpus / Q000000981:diagnostic imaging / Q000293:injuries*; D008875:Middle Aged; D010019:Osteomyelitis / Q000209:etiology* / Q000628:therapy; D010406:Penicillins / Q000627:therapeutic use; D011859:Radiography; D014950:Wounds, Penetrating / Q000150:complications*
D010406:Penicillins