A 21 year-old female with no past medical history presented to the emergency department (ED) with ring finger pain and swelling of her right hand over the past six days. According to the patient, she initially developed a paronychia on the finger one week after getting her nails done.

She went to an urgent care center for drainage of the paronychia and was also started on trimethoprim-sulfamethoxazole. She presented to the ED six days later for worsening pain and swelling of her finger despite taking the antibiotic as prescribed. She also noted decreased range of motion as well as mild numbness and tingling of the ring finger.

Vital signs were normal. On exam, the patient’s right fourth digit was edematous and held in flexion.

Range of motion testing was limited due to pain elicited with any movement of the digit. Tenderness on palpation was most severe at the distal digit and the overlying skin was erythematous.

Laboratory values, including a blood cell count, chemistry panel, erythrocyte sedimentation rate, and C-reactive protein, were within normal range.

Plain films showed diffuse soft tissue swelling of the 4th digit with no bone or joint space abnormalities.

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