Paronychia and Lymphangitis

Exquisite pain of 3-days' duration in his right index finger sent a 19-year-old man for medical consultation. He recalled that a thorn had become embedded in the finger while gardening 1 week earlier.

The nail fold of the finger was red, hot, swollen, and tender. A foreign object was clearly visible beneath the proximal edge of the fingernail. A tender, linear, red streak extended up the patient's right forearm. Paronychia and lymphangitis were diagnosed.

A 13-mm thorn was removed from the affected finger. Approximately 2 mL of pus was drained through an incision in the nail fold. Culture of the fluid showed heavy growth of group A streptococci.

The patient was treated with a 10-day course of cloxacillin; his recovery was uneventful.