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Case Records of the Massachusetts General Hospital
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Volume 360:281-290 January 15, 2009 Number 3
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Case 2-2009 — A 25-Year-Old Man with Pain and Swelling of the Right Hand and Hypotension
Michael R. Filbin, M.D., David C. Ring, M.D., Ph.D., Michael R. Wessels, M.D., Laura L. Avery, M.D., and Richard L. Kradin, M.D.

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Presentation of Case

Dr. William D. Binder (Emergency Services): A 25-year-old man was transferred to the emergency department of this hospital because of pain and swelling of the right hand and hypotension.

The patient had been well until 2 days earlier, when he noticed a lesion on the dorsum of his right hand, which he thought was an insect bite. The next day, the hand became swollen and painful, and he felt ill. In the evening, he had difficulty using his hand while working on a computer. The next morning, he had chills, and his temperature rose to 38.6°C. At 5 p.m., the . . . [Full Text of this Article]

Differential Diagnosis

Discussion of Management

Early Goal-Directed Therapy for Septic Shock

Surgical Management of Necrotizing Fasciitis

Dr. Michael R. Filbin's Diagnosis

Pathological Discussion

Group A Streptococcus

Necrotizing Fasciitis

Streptococcal Toxic Shock Syndrome

Antibiotic Therapy

Anatomical Diagnosis


Source Information

From the Departments of Emergency Services (M.R.F.), Orthopaedics (D.C.R.), Radiology (L.L.A.), Pathology (R.L.K.), and Medicine (R.L.K.), Massachusetts General Hospital; the Division of Infectious Diseases, Children's Hospital (M.R.W.); and the Departments of Surgery (M.R.F.), Orthopaedic Surgery (D.C.R.), Pediatrics (M.R.W.), Radiology (L.L.A.), Pathology (R.L.K.), and Medicine (R.L.K.), Harvard Medical School — all in Boston.



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