Case Presentation:
Patient: 82-year-old man
Clinical Presentation: The patient presented with a lesion on his left hand that initially appeared as a pustule 5 years ago. Over time, the lesion grew in size and became suppurative. In 1995, the first signs of the lesion appeared, and the patient underwent excision. However, the lesion continued to grow, leading to a biopsy in 1997, which revealed tissue granulomatosis. Subsequent biopsies in 1998 showed actinomycosis and gout-related foreign body. The patient reported being asymptomatic until 5 years before admission when the lesion resurfaced. Another biopsy in 2021 confirmed the presence of Actinomycosis and mycetoma.
The patient underwent a simple radiograph of the palmar bones, which revealed affected bones. To further evaluate the extent of the infection, an MRI scan was performed. The Axial T2 and T1 weighted images showed abnormal signals indicative of osteomyelitis in the distal row of carpal bones and proximal regions of the second, third, and fourth metacarpals. Additionally, cortical destruction of the second metacarpal bone was observed. The MRI images also demonstrated the presence of collections in both the volar and dorsal sides of the hand, extending into the intercarpal spaces. The volar abscess had compressed and displaced the carpal tunnel volarly.