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This guy didn't get a butt enhancement from some backstreet clinic did he? You know to make his ass look like a movie stars? Did they inject cement or something in there that they shouldn't?

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No he didn't, but to go off topic, I heard on the radio this morning that scrotal de-wrinkling is an up and coming trend. Who's made their appointment?

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Ok. So he's got an infection somewhere. By what we've got here so far he meets SIRS criteria (tachy and WBC >12) for a sepsis alert.

C'mon Doc. He got a scrotal dewrinkling that went horribly wrong, didn't he?

Let's draw cultures. Let's get a lactate, too. Keep the fluids going in.

Are we at the hospital yet? If so I expect they'll start this guy on wide spectrum (vanc, tazo/piper) until the cultures come back to better specify antibiotic treatment.

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Cultures drawn and sent. Lactate 1.3 (normal is less than 1.8)

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Whats his liver feel like on palpation??

IV drug user ????????

Hepatitis????

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Liver is soft, non tender and not enlarged. He has a history of IV drug use but has not used anything in 3 months.

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I am going with septis. Had a young guy get a spider bite on the leg. All the same symptoms. Was medivaced intubated with a 50/50 chance of survival.

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I will give you a hint. You aren't going to get anything else out of your physical exam. You have a young, sedentary guy with severe buttock/posterior thigh pain. The pain is out of proportion to exam. He is afebrile. No one has discussed his EKG. He has elevated LFTs and acute renal failure. How can we tie all of these things together?

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Well his AST/ALT levels make me think alcoholic hepatitis which is linked with acute renal failure, the EKG looks like it has peaked T waves meaning hyperkalemia. I'm still stumped as to why he's having leg/butt pain though.

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Well, I'm not sure how it makes sense here, but the ECG looks suspicious for Brugada syndrome, and shows a long QT.

I had wondered about CES -- but there's no fecal incontinence / urinary retention / sexual dysfunction reported. However, this could cause renal failure and explain some / most of the symptoms.

He hasn't done anything silly like trying to inject some heroin IM into his glute, instead of IV?

No hx of CA?

Is it lupus?


Why do I feel that the answer will make me fell stupid.


AAA?


Conversion disorder?

Exercise-induced asthma?


spinal abscess?

Edited by systemet

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