A 46-year-old man presented with pain, redness, and swelling on his right hand. He was an intravenous drug addict with a history of heroin use, though he denied sharing needles. The symptoms had started after he had attempted to inject himself, and the wound had progressively worsened, leading to limited hand movement accompanied by fever and chill.
He also had a history of uncontrolled diabetes mellitus, chronic hepatitis C infection, hypertension, and chronic stage III kidney disease. Physical examination: Temperature: 100.3 o F Pulse: 96 beats/min Blood pressure: 177/96 mm Hg Respiratory rate: 13/min His other physical examinations were unremarkable except for erythema, pain, decreased sensation, and limited right hand movement. Laboratory tests: WBC: 10,800/ μ L Neutrophils: 80.8% Lactate: 2.8 meq/L Right-hand X-ray showed swelling of dorsal soft tissue without any other…
