Our latest case report from Brady Pregerson, MD, features a man in his 30s with a history of type 1 diabetes mellitus on insulin presenting to the emergency department for left index finger pain and swelling. Can you determine the correct diagnosis?
History of Present Illness:
A man in his 30s with a history of type 1 diabetes mellitus on insulin presents to the emergency department for left index finger pain and swelling. He states about a week ago he had a puncture wound to the tip of that finger from a frayed bike cable. He removed a foreign body but the pain never went away. In the past 24-36 hours it has become rapidly more painful and swollen and he can’t straighten his finger. He denies any drainage, fever, or other complaints.
Vital Signs & Physical Exam:
Vital signs are normal. Physical exam is normal except for the images below:
Initial Diagnostic Testing:
Labs: WBC: 14. Glucose: 220; Bicarb: 21; Other labs normal
Imaging: Hand x-ray showed no foreign body, gas, or bony involvement
What is the most likely diagnosis?