PMC4312609_01
Inflammatory nodules on the left hand on second admission.
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Patient was discharged home on trimethoprim/sulfamethoxazole oral tablets but readmitted seven days later with pain and pustules now mainly on all of the fingers of the left forearm (Figure 1).
MRI of the left arm showed multiple ulcerations extending from skin into subcutaneous fat with appearance concern for necrotizing fasciitis and osteomyelitis.
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Despite being adherent to this regimen for four weeks, he was ultimately readmitted a third time with new abscess formation on medial aspect of his proximal LUE and repeated MRI showing osteomyelitis of the left distal ulna (Figure 2).
Patient's left hand at his 9-month follow-up.
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Because of extensive disease and slow improvement on therapy, our patient received nine months of antibiotics therapy with good response (Figure 3).