A 62-year-old nurse presents to your clinic with a six-month history of pain and swelling involving her third

finger.

She has been treated sequentially with cephalexin, amoxicillin-clavulanate, and clindamycin without effect.

She is an avid gardener and enjoys digging for clams in a marshy area near to her home. She admits to

frequent abrasions and scratches.

MRI has demonstrated diffuse soft tissue inflammation with tenosynovitis, septic arthritis of the

interphalangeal joints, and early phalangeal osteomyelitis.

What is the most likely microbiologic agent?

A. Methicillin-resistant Staphylococcus aureus

B. Aeromonas hydrophila

C. Nocardia nova complex

D. Nontuberculous mycobacteria

E. Sporothrix schenckii


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