Clinical Photo and X‐Ray Quiz: An Infected Toe

A 36-year-old manual worker complained of persistent discharge from a wound on his right fifth toe for a week. The patient had a history of right fifth toe contusion, which resulted in bruising and haematoma formation two weeks earlier. At that time he consulted a bonesetter who punctured the haematoma and applied herbal medicine locally. He attended our emergency department (ED) because of discharge from and redness of the puncture wound. The wound discharge was sent for culture and sensitivity tests. X-ray examination of the toe was performed and was normal. He was discharged with a course of ampicillin and cloxacillin. He was called back to the ED a week later because the wound swab grew methicillin-resistant Staphylococcus aureus (MRSA). A clinical photo was taken (Figure 1) and a second X-ray examination (Figure 2) was performed.