erysipelothrix rhusiopathiae is a gram - positive bacterium that is mainly responsible for skin infection , mostly erysipeloid , in humans . the infection derives from direct contact with infected animals , usually domestic swine , and their products or wastes . we report a rare case of a 30-year - old woman with tenosynovitis of her right middle finger . a 30-year - old nigerian woman was admitted to our department with a medical history of swollen and painful middle finger of her right hand , which had progressively worsened over the last 3 days . physical examination revealed edema , pain at rest , warmth and a reddish middle finger with extension to the volar and dorsal area of her hand . although the range of motion of the interphalangeal and metacarpophalangeal joints was completely restricted , no vascular impairment was documented . her peripheral white blood cell count was 13  300/l ( 71% neutrophils , 17.8% lymphocytes , 10.1% monocytes ) , and c - reactive protein was 0.33  mg / dl ( normal range , 0.50.7  mg / dl ) . the diagnosis was tenosynovitis of both the flexor and extensor mechanisms of the middle digit . under brachial block , a straight incision was performed dorsally , while a bruner incision was preferred for the palmar area . during dissection , a serous fluid , but no pus , was collected and sent for culture . copious irrigation with saline and hydrogen peroxide was performed during surgical exploration . empirical intravenous antibiotic therapy was initiated immediately after surgery , including cefuroxime ( 750  mg/8 hours ) , ciprofloxacin ( 500  mg/12 hours ) and clindamycin ( 600  mg/8 hours ) . fluid culture revealed enterococcus faecalis in the first 24 hours , while a gram - positive bacterium grew after 48 hours ( fig .  1 ) , which proved to be erysipelothrix rhusiopathiae . the pathogen was sensitive to penicillin , ampicillin , imipenem , cefuroxime , ceftriaxone , clindamycin and linezolid , while being resistant to vancomycin , teicoplanin , trimethoprim  sulfamethoxazole and tetracycline . the patient continued antibiotic therapy for 2 weeks , followed by 2 weeks of oral antibiotics after being discharged from hospital . within the 3 months ' follow - up , the inflammation markers were within the normal range , and the patient regained mobility in her digit after an intensive physiotherapy programme ( fig .  2 , fig .  3 ) . no signs of recurrence of the disease or of osteomyelitis were detected during follow - up . erysipelothrix rhusiopathiae was first isolated in 1876 by koch   in a mouse . not until 1884 it is considered to be a gram - positive , capsulated saprophyte , with worldwide spread and affecting mostly domestic and wild animals . erysipelothrix 
  is referred to as an occupational bacteria because its contact with infected animals or their waste causes a variety of clinical syndromes . sheep , chickens , rodents , shellfish , turkeys and ducks are usual hosts , but domestic swine is the dominant reservoir for the microorganism . it is not only professional workers , such as fishermen , farmers or butchers , who are considered to be at high risk when in close contact with infected animals . infection can also be accidental , the result of its ability to remain viable in water and animal products , such as ham , or in fish for a long period without forming spores . it is a mild , cutaneous infection , lasting between 2 and 4 weeks and usually self - limiting . lesions are confined to fingers and hands , which are being swollen and painful , with spreading at the periphery and decolourization of the central area . systemic effects are rare , although lymphadenopathy and lymphangiitis are detected in one third of patients . the diffuse cutaneous form is even rarer , combined with systemic symptoms such as fever , severe headache and even polyarthritis . the most severe form of infection , though the rarest , due to erysipelothrix is septicaemia , which is almost always related to endocarditis . risk factors for bactaeremia include diabetes , immunosuppression , alcoholism   or renal failure as well as infancy . although rarely mentioned in the orthopaedic literature , reports from the last decade show that erysipelothrix rhusiopathiae is considered to be a causative bacteria for reactive arthritis , osteomyelitis , prosthetic infection   and spondylitis . although it is a known occupational pathogen , its infections are often misdiagnosed . in cases of erysipeloid , biopsy samples should be taken of the entire thickness of the dermis , as the bacterium lies in the deeper layers of the skin . specimens must be put in an infusion broth of 1% glucose at room temperature until reaching the laboratory . identification should be based on gram stain , morphology , motility , and hemolytic and biochemical properties , especially production of h2s . generally erysipelothrix should not be confused with actinomyces , lactobacillus , streptococcus , listeria monocytogenes or enterococcus spp . penicillin , cephalosporins , fluoroquinolones and lincosamides are the main antibiotic categories used for treatment against infections due to erysipelothrix . the bacterium is highly resistant to aminoglycosides , vancomycin , sulfonamides , streptomycin and trimethoprim  sulfamethoxazole . penicillin g   is considered the drug of choice , in doses varying from 12    10 to 20    10 u / day . duration of treatment period depends on whether or not the infection is systemic . in cases of bactaeremia or endocarditis , 4 to 6 weeks of continuous antibiotic therapy is considered an effective treatment period . in complicated cases   or in cases of immediate recurrence of the disease , antibiotics can be administrated for up to 16 weeks . orthopaedic surgeons should be aware of infections due to erysipelothrix rhusiopathiae , bearing in mind the close correlation between certain professions and animals , domestic or wild . systemic or not , such infections must be identified immediately in order to prevent severe complications such as endocarditis . prophylactic measures can reduce occupational exposure and minimize the possible transmission of the pathogen to humans .
erysipelothrix rhusiopathiae is a gram - positive bacterium that in humans causes skin infections , such as erysipeloid , as a result of direct contact with contaminated animals or their waste or products . 
 we present the first reported case of tenosynovitis of a finger in a 30-year - old woman .