When You Hear Hoof Beats, Think Zebras? An Unusual Case Of Low Back Pain In An Adolescent Athlete.

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When You Hear Hoof Beats, Think Zebras? An Unusual Case Of Low Back Pain In An Adolescent Athlete. - Page #3

Lab Studies: Urinalysis was normal. Urine and blood cultures showed no growth. ESR had borderline elevation of 29. CRP was within normal range (0.85). CBC showed normal WBC (7.7), H&H (11.9/34.2), and platelets (240). Other Studies: Lumbar spine x-rays Case Photo #1 showed no fracture, normal alignment, disc space narrowing at L3-4 with associated endplate abnormalities at L3-4 (read as unremarkable in ER initially). MRI lumbar spine with and without contrast Case Photo #2 showed extensive L3-4 discitis and osteomyelitis with extension into right psoas and paravertebral space without drainable abscess. Anaerobic and fungal cultures from the bone core biopsy and disc biopsy showed no growth. Gram stain was negative. Pathology was consistent with osteomyelitis. Consultations: Infectious Disease and Orthopedic Surgery were consulted. Click here to continue. Challenge yourself by writing down a revised, working diagnosis before moving to the next slide.		Back
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