December 1988

'Punch' Actinomycosis Causing Osteomyelitis of the Hand

Author Affiliations

From the Departments of Medicine (Drs Spagnuolo and Blinkhorn), Orthopedics (Dr Strimbu), and Emergency Medicine (Dr Effron), Case Western Reserve University at Cleveland Metropolitan General Hospital.

Arch Intern Med. 1988;148(12):2668-2670. doi:10.1001/archinte.1988.00380120112022

• Osseous actinomycosis usually results from direct invasion of bone from adjacent soft-tissue infection. Involvement of the jaw and vertebral column has been frequently reported, but involvement of the bones of the wrist or hand is rare. A patient with osteomyelitis of the distal right first metacarpal bone due to Actinomyces israelii following a punch injury during fisticuffs is described. Review of similar cases revealed a striking association of this type of infection with punch injuries; hence the term, punch actinomycosis. Analysis of the pus in these infections typically reveals sulfur granules; strict anaerobic conditions must be employed to culture the etiologic agent, A israelii. Management of individual cases should include surgical débridement combined with high-dose parenteral penicillin, followed by long-term penicillin therapy, orally.

(Arch Intern Med 1988;148:2668-2670)