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.