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50ish man w/ DM s/p renal tx p/w pneumonia & delirium. RN puts on mitts. Next day, his finger hurts. On physical exam, you note fusiform swelling, tenderness along palmar aspect of the finger, and pain with passive extension. What’s your ddx? #Physicalexamfriday #IDconsults 
The patient met 3 out of 4 Kanavel criteria for pyogenic flexor tenosynovitis (fusiform swelling, tenderness over the tendon, pain with passive extension, finger in slight flexion). MRI confirmed the diagnosis and orthopedic surgery took him to surgery for debridement...
Dr. Kanavel was a surgeon at Cook County who described the signs in 1912. They have been used ever since and were finally validated over a hundred years later in 2017 (Hand (N Y). 2017 Nov;12(6):585-590). I got my hands on a copy of his original book!
Pyogenic flexor tenosynovitis is important to recognize early because it functions like an abscess and can track up the arm through the compartments of the hand. “Just A Cut” in @NEJM is a striking reminder of this (N Engl J Med 2016; 375:1780-1786).
Typical pathogens in pyogenic flexor tenosynovitis include gram (+) Staph/Strep organisms but this gentleman grew a Zygomyces mold, Absidia spp. See tape prep of the mold.
He underwent urgent amputation for source control and liposomal amphotericin. We suspected the mitts may have been the source of the mold infection via small breaks in the skin from blood from blood sugar checks. See Clin Infect Dis Vol 68, Issue 5, 1 March 2019, Pages 850–853.
Hope you enjoyed this #tweetorial and don’t forget to recognize pyogenic flexor tenosynovitis when you see it in the future. Recognition is key to timely treatment! #PhysicalExamFriday #IDconsults
