Case 10

Case Presentation:

A 39 year-old male with a 16 year history of IV drug use presented to the ER with a four day history of intense left buttock pain which radiated down his left leg posteriorly. He complained also of fever and night sweats. The pain would awaken him from sleep. He admitted to use of IV drugs including cocaine and heroin. He had last injected himself with cocaine three days prior to admission. He had injected with a clean, sharp needle. He had no history of shooting into his leg veins or his abdomen. He had had no trauma to his pelvis or hips. He had no cough, chest pain, SOB, or sputum production. He had no history of TB, STD or RHD or joint disease. He had no history of hepatitis and reported a negative test for AIDS 18 months prior.

Three days prior to admission he was seen in the ER of another hospital with similar complaints and a rectal temp of 103.8. Labs had shown a WBC of 15,9000 and a II/VI systolic murmur was noted. Admission was offered but the patient refused. He now presented because of increased buttock pain which had progressed to such a degree that he was unable to get out of bed.

Physical exam revealed an ill appearing young man. He was immobile in bed and complained of severe pain. There was no swelling, redness or fluctuance over the left SI area. He had full ROM of the right hip which elicited pain in the left SI area. The left hip also had full ROM and caused pain. Initial evaluation included a CBC which showed a WBC of 17,200 (71P/3B/19L). He was begun on broad spectrum antibiotics.

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Full Case Report

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J. Anthony Parker, MD PhD, jap@nucmed.bih.harvard.edu