A 48-Year-Old Man With Swollen, Painful Areas on His Thumbs

Andrew Melone, MD; David F. Baehren, MD


January 06, 2020

Editor's Note:
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A 48-year-old man presents to the emergency department (ED) with a 10-day history of intermittent subjective fever and pain in his hands. He has also noticed 2 swollen and painful areas on his thumbs. Concurrently with the fever, he reports weakness, malaise, watery diarrhea, weight loss, anorexia, and intermittent vomiting. He denies having any cough, dyspnea, headache, chest pain, abdominal pain, hematemesis, or hematochezia.

His medical history includes hypertension, deep venous thrombosis without a known coagulation disorder, nephrolithiasis, peptic ulcer disease, and a methicillin-resistant Staphylococcus aureus cellulitis. His surgical history includes a right leg above-the-knee amputation resulting from a gangrenous infection acquired during a natural disaster years ago. The leg healed well and without complications. He has no medical or seasonal allergies. The patient takes lisinopril, 20 mg daily; amlodipine, 5 mg daily; carvedilol, 25 mg daily; and ibuprofen as needed for pain. He is not currently taking any blood-thinning agents.

The patient admits to occasional tobacco, cannabis, and alcohol use but denies injection drug use. He reports no remarkable family history. The patient had recently been admitted to another hospital, but he left before completing treatment and does not know his diagnosis.


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