Surprise Abscess Afoot

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Surprise Abscess Afoot - Page #3

Lab Studies: Sodium: 137, Potassium 3.5, Chloride: 107, CO2:21, BUN 13, Creatinine 0.70, Glucose 75, Hemoglobin A1C: 5.1 <br> <br>WBC 12.7, Hemoglobin 14.1, Hematocrit 40.5, Platelets 317 <br> <br>Blood culture: no growth <br> <br>Beta hcg: negative <br> <br>C reactive protein (CRP) 11.8, Erythrocyte sedimentation rate:16 <br> <br>Creatinine kinase 1,295 <br> <br>ANA: negative, Rheumatoid Factor: negative <br> <br>Chlamydia and Gonorrhea NAAT: negative, HIV antibody: non-reactive Other Studies: Right foot Xray 3 views (on admission): No evidence of fracture, dislocation or other significant abnormality. <a href="CaseStudyImages/CS1SurpriseAbscessAf-838.jpg" title="Case Photo #1" data-lity><b>Case Photo #1</b></a> <a href="CaseStudyImages/CS2CS1SurpriseAbsces-838.jpg" title="Case Photo #2" data-lity><b>Case Photo #2</b></a> <br> <br>Right foot MRI w and w/o contrast (hospital day 2): Prominent increased signal most prominently involving the abductor digiti minimi muscle laterally and to a lesser extent the abductor hallucis muscle medially. No discrete drainable fluid collections identified. There is also likely reactive marrow edema involving the calcaneus. <a href="CaseStudyImages/CS3CS2CS1SurpriseAbs-838.jpg" title="Case Photo #3" data-lity><b>Case Photo #3</b></a> <br> <br>CT scan w/o contrast (hospital day 4): Focal fluid collection adjacent to the plantar and lateral aspect of the calcaneus and cuboid measuring approximately 5 x 4 x 2 cm. No CT evidence for osteomyelitis. <a href="CaseStudyImages/CS4CS3CS2CS1Surprise-838.jpg" title="Case Photo #4" data-lity><b>Case Photo #4</b></a> Consultations: Orthopedics: unlikely septic arthritis <br>Rheumatology: recommended CT that was done above, recommended trial of prednisone 60mg before CT was done to see if inflammatory process causing pain. Click here to continue. Challenge yourself by writing down a revised, working diagnosis before moving to the next slide.		Back
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