An Unusual Case Of Buttock Pain

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An Unusual Case Of Buttock Pain - Page #3

Lab Studies: Labs August 2016 CBC: WBC 6.7, HGB 12.9, HCT 39, Plt 206 ESR 38 CRP 0.1 RF 6.9 HLA-B27 neg. Labs December 2016 ESR 15 CRP less than 0.1 Bartonella Henselae Ab less than 1:64 Brucella total Ab less than 1:20 Coccidioides serology neg Q-fever Ab IgG neg Quantiferon TB Gold neg. Labs March 2017 CBC: WBC 10.4, HGB 13.5, HCT 40.3, Plt 238 RF less than 10 HLA-B27 neg. CMP: Na 138, K 4.7, Cl 102. CO2 26, BUN 12, Cr 0.57, Glucose 89 Ca 9.7 LFTs: TP 7.6, Alb 4.1, AST 29, ALT 19, Tbili 0.4, Dbili NR, ALP 518 ESR 9 CRP less than 0.1 Other Studies: XRs AP pelvis / SI joint / LS spine (12/2015) - unremarkable Case Photo #1 MR Pelvis wo contrast (12/2015) - SIJ intense edema into left hemisacrum/ilium with left SI effusion, diastasis. 1.6 cm lobulated hematoma anterior to the SIJ with apex at SIJ anterior margin. Case Photo #2 Repeat T/L/S-spine XR (3/2016) - unremarkable spine but with SI joint sclerosis. Case Photo #3 Pelvis XR (9/2016) - increased sclerosis, erosive/destructive changes of left SIJ. concern for inflammatory/infectious erosive process. MR pelvis w/wo contrast (10/2016) - osseous sclerosis, widening, erosive changes, synovitis of left SI joint. adjacent rim-enhancing fluid collection. concern for septic arthritis, intraosseous abscess, adjacent osteomyelitis in left sacral ala. Case Photo #5 Left SI joint biopsy pathology (2/2017) - bone marrow fibrosis, chronic inflammation. suggestive of a reactive/inflammatory process. MICRO - GS = 2+ RBC, no WBC/organisms Bacterial culture - +1 colony P acnes +S epidermidis in broth only Fungal cx felt to be contaminants AFB smear, culture neg. Consultations: Orthopedic surgery - did not recommend surgical intervention Pediatric Infectious Disease - recommended the above serologies and CT-guided biopsy and aspiration Click here to continue. Challenge yourself by writing down a revised, working diagnosis before moving to the next slide.		Back
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