CASE
Mrs. M, a 28-year-old female, presented to the missionary clinic in Niger, West Africa, with a 3-month history of swelling in her right first finger. The swelling extended proximally to the wrist and had grown larger and stiffer. The patient denied any pain and did not recall any history of trauma. She had recently noticed more areas of excoriation and purulent discharge from the involved tissues. No fever, night sweats, or cough were present.
History The patient had no health care facilities in her community and had traveled 2 days on a donkey cart to the clinic. To care for her three children, the patient hauled wood for fire, which she used to make food to sell. She denied drinking or smoking.
Examination On examination, the patient appeared to be in no distress. Her vital signs were normal. A markedly enlarged right first finger extending proximally to the wrist was evident (Figure 1). The skin in the surrounding area showed excoriation, and isolated patches emitted yellow discharge. Sinuses were noted, and discharge could be expressed from them when pressure was applied. No obvious erythema or warmth was present. Active and passive range of motion was very limited. The first finger was restricted to the extensor position with very little flexion ability. The patient had no grip strength in the right hand. HIV antibody test results were negative.
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