A 54-year-old man presents with a four-day history of a rapidly enlarging, painful, draining nodulo-pustule on the side of his finger. He was unsure but said he might have cut it at work. The patient was on blood pressure medication but otherwise healthy. What is your diagnosis?
Diagnosis: MRSA Infection
A culture confirmed Methicillin-resistant Staphylococcus aureus (MRSA) sensitive to trimethoprim/sulfa antibiotics. The patient was initially started empirically on a Zithromax Z-Pak, but when results came back on Day Two, it was discovered that the bacteria was resistant to erythromycin. He was switched to Bactrim DS, 1 PO BID for 14 days. He was also sent to an orthopedic hand specialist to rule out any osseous involvement (there was none). He noticed remarkable improvement after starting the Bactrim. Here is a picture of the finger 21 days after initiating treatment.
For more information, contact Charles E. Crutchfield III, MD, at Crutchfield Dermatology or visit www.crutchfielddermatology.com.