A 17-year-old boy complained of pain and swelling on the dorsal side of his left hand for more than 2 months. He had no known medical conditions and was not receiving medications. Physical examination showed a hard and suppurative nodule around the left third metacarpal. He had no fever or systemic symptoms, no lymphadenopathy, and no history of trauma. Results of serologic testing for the human immunodeficiency virus were negative.
Radiography of the left hand revealed a slightly thinned cortex surrounding a lytic core with trabecular pieces on the third metacarpal bone (arrow); no periosteal reaction was seen. Chest radiography was normal. Image source: NEJM What could be the differential diagnosis in this case? What further investigation would you suggest for the confirmation? *This case is from Docplexus Editorial Team for educative purpose only.
