Deep Penetrating Kerosene Exposure in the Hand Mimicking Deep Space Infection

Area of Science:

• Hand Surgery
• Toxicology
• Wound Management

Background:

• Penetrating hand injuries require prompt evaluation and management.
• Hydrocarbon exposure can lead to complex soft tissue reactions.
• Distinguishing infection from sterile inflammation is critical in wound care.

Observation:

• An adolescent presented with a midpalmar hand abscess after a penetrating wound from a kerosene-containing thermometer.
• Initial surgical intervention included irrigation and debridement of purulent material.
• Cultures and pathology results were negative for infection.

Findings:

• Kerosene exposure can induce a sterile inflammatory response, clinically resembling an acute bacterial abscess.
• Intraoperative findings demonstrated sterile purulence, inconsistent with typical infection.
• The hydrocarbon substance itself was the likely cause of the inflammatory reaction.

Implications:

• Hand surgeons should consider hydrocarbon exposure in cases of sterile hand abscesses.
• Early and thorough surgical irrigation and debridement are essential for managing deep soft tissue exposure to hydrocarbons like kerosene.
• Awareness of hydrocarbon's potential to mimic infection is vital for appropriate patient management and surgical decision-making.