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Pain and swelling along the nail fold of a 51-year-old man

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Pain and swelling along the nail fold of a 51-year-old man
Kelly J. Warren, M.D. and Janet A. Fairley, M.D
Dermatology Online Journal 4(1): 1

Case Report

Figure 1
Figure 1: Right third finger.

A 51-year-old man presented with a 2 month history of pain and swelling that began along the nail fold of the right third finger and progressed to involve the dorsal hand. The patient stated that the initial lesion appeared approximately two weeks after he had been cleaning aquaria. He recalled getting gravel from the fish tanks lodged underneath the nail of the affected finger. 

A ten day course of oral amoxicillin/clavulanate produced no improvement. Lesional tissue obtained by punch biopsy from a nodule on the dorsal hand and stained with hemotoxylin and eosin revealed several dermal granuloma, foreign body giant cells, neutrophils, and eosinophils; however, there were no visible organisms.

Figure 2Figure 3
Figure 2: Granulomatous nodular lesions on back of hand showing proximal lymphangitic spread.
Figure 3: Dermal granulomatous infiltrate.

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