Complicated Cat Bite with Suspected Deep Tissue Involvement in Diabetic Patient
Case at a Glance
A 38-year-old female with mild diabetes and connective tissue disorder presented with a severe cat bite to the left hand with four deep puncture wounds, concerning for tendon involvement and inadequate response to oral antibiotics after 48 hours.
Patient's Story
The patient, with a history of mild diabetes controlled with GLP-1 agonists, hEDS, and POTS, sustained multiple deep cat bite wounds to the dorsal aspect of her left hand while separating fighting cats. She reported feeling the cat's teeth contact the tendons during the bite. Given her history of recurrent pasteurella infections from previous cat bites, she sought immediate medical attention. The patient had recently undergone prolonged tattoo work, potentially compromising her immune status.
Initial Assessment
Emergency department evaluation revealed four puncture wounds on the dorsal left hand - three in thin skin areas and one deep wound in the thenar web space. X-rays showed no bone involvement. The patient was started on metronidazole 500mg three times daily and doxycycline 100mg twice daily due to reported amoxicillin allergy. Initial wound irrigation was performed.
The Diagnostic Journey
At 48 hours post-injury, despite antibiotic therapy, the patient experienced worsening pain, progressive swelling, and functional impairment of the index finger. She reported inability to bear weight on the index finger, difficulty with thumb-to-finger opposition, and intermittent paresthesias. Wound drainage consisted of serosanguinous fluid. Low-grade fever of 99.6°F was noted, though potentially masked by concurrent ibuprofen use. The patient expressed concern about possible tendon involvement given the mechanism of injury and persistent functional deficits.
Final Diagnosis
Deep cat bite wounds with suspected tenosynovitis and inadequate response to oral antibiotic therapy in a diabetic patient. High risk for pasteurella multocida infection with possible deep tissue involvement.
Treatment Plan
Given the patient's diabetes, history of recurrent pasteurella infections, suspected tendon involvement, and poor response to oral antibiotics after 48 hours, surgical consultation for wound exploration and irrigation was recommended. The case highlighted the need for more aggressive management in diabetic patients with deep cat bites, potentially requiring intravenous antibiotics and surgical debridement.
Outcome and Follow-up
The patient was advised to return to the emergency department for urgent evaluation given the lack of clinical improvement and concerning functional deficits. Standard of care for diabetic patients with deep cat bites typically includes surgical washout and more aggressive antibiotic management to prevent serious complications including osteomyelitis and permanent tendon damage.