Deep Palm Infection – Franko

History:  71 year old female presented to the hospital about 2 weeks after a fall with increasing pain and swelling in her hand and palm. She had a history of psoriatic arthritis for which she took methotrexate and infliximab.  Her presentation was very concerning for a deep infection with a WBC of 41,000, lactate of 2.6, and a CT scan in the emergency department showing a deep abscess around the median nerve. 

Diagnosis: Left palm deep space infection in the setting of immunosuppresion

Treatment: Urgent I&D of the deep space through an extended carpal tunnel incision, before and after photos

Outcome: She made a rapid recovery with IV antibiotics. Ultimately she was able to regain nearly all of her function and return to her usual daily routine.