Finger granuloma

THIS patient finished a third course of antibiotics for a presumed infective swelling over the PIP joint of the middle finger with no real benefit. The swelling had been present for six months and is more likely to be a deep fungal or atypical mycobacterial infection.

Enquire about a fish tank at home for Mycobacterium marinum infection and whether the patient is a keen gardener for sporotrichosis (a deep fungus found in old wood or mulch).

Take a punch biopsy of the lesion for histology looking for granulomas, and send another specimen in an empty container for culture but specify for deep fungi and mycobacteria. The culture may take six weeks to grow.

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