On exam, he has severe pain with extension of the hip and limited hip movement. He prefers to be in a position with hip flexion and lumbar lordosis. Laboratory studies show WBC 12,000/mL, Hgb 10 g/L, elevated ESR and CRP. A CT is shown below:
The white arrow indicates where aspiration was done. A routine gram stain and bacterial culture were sent but they are negative. Routine bacterial cultures of the blood are negative as well.Challenge: What's the diagnosis and what is the cause?
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4 comments:
Hmm that looks like an abscess... hmm that looks like the psoas... psoas abscess! Yesssssss.
Cause: Tuberculosis/Pott's
TB Pyelonephritis? PCR for TB, ZN stain of the Aspirate with Culture on LJ medium to confirm?
Fingers really crossed on this one..
haha yes, its tb causing a psoas abscess.
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Immigration
This is a psoas abscess; the bacteriology is most often Staph aureus and Mycobacterium tuberculosis in endemic areas (sub-Saharan Africa, India, China, Southeast Asia, Micronesia). With negative cultures and a history of living in an endemic area, TB must be suspected.
Sources: UpToDate; "Extrapulmonary Tuberculosis: An Overview" by Golden and Vikram from www.aafp.org.
damn! :( dunno wat i was thinking! atleast i got the TB part right...
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