A 23 year-old shipyard worker presented with increasing pain and swelling of the right hand over 2 days (Fig 1). A plain X-ray showed no soft tissue gas or osteomyelitis. Blood investigation identified a leucocytosis of 33.1 x 10~9/L. He was treated empirically with broad-spectrum antibiotics, including intravenous penicillin and clox-acillin, but the pain and swelling did not improve over 48 hours. Ultrasound showed abscesses in the thenar and dorsal subaponeurosal deep spaces. Urgent incision and drainage and debridement were carried out through dorsal and palmar incisions. At surgery, he was also noted to have bilateral epididymo-orchitis with a superficial abscess of 7 cm diameter of the right hemiscrotum. This was also incised and drained. Prior to surgery, the patient had not volunteered a history of scrotal infection. On questioning, he reported occasional scrotal aches and discharge for the past 2 years, for which he had not previously sought any medical attention.
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