PMC4260285_01
Dorsal aspect of hand showing swelling and multiple sinuses
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F1
Physical examination was normal except a swelling in the left hand that extended from wrist to metacarpophalangeal joint of all the fingers, along with multiple discharging sinuses at the dorsal and palmar aspects of the hand [Figures 1 and 2].
Palmar aspect of showing swelling and discharging multiple sinuses
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F2
Physical examination was normal except a swelling in the left hand that extended from wrist to metacarpophalangeal joint of all the fingers, along with multiple discharging sinuses at the dorsal and palmar aspects of the hand [Figures 1 and 2].
Histopathological study showing radiating filaments, surrounded by eosinophilic hyaline material
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F3
Finally, curettage and biopsy of the draining sinuses was made, which revealed many neutrophils with some colonies consisting of radiating filaments, surrounded by eosinophilic hyaline material creating a sun-ray pattern, similar to that of actinomycosis [Figure 3].
Photograph showing surgical debridement of the lesion
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F4
Hence, a diagnosis of primary actinomycosis of hand was made for which he was treated with surgical debridement [Figure 4] and intravenous and oral penicillin therapy for 6 months to which patient showed excellent response.