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UnFiNiShEd CaSe CoMe BaCk LaTeR

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History of Present Illness:

A 52-year-old male presents to the ED for fever, body aches and urinary frequency.   He denies any abdominal or flank pain, dysuria, unprotected sex, polydipsia, thirst  or other complaints

Vital Signs & Physical Exam:

Vital signs normal except for temperature of 102.o.  Physical exam otherwise normal.  There is no abdominal or flank tenderness.

Initial Differential Diagnosis:

  • Cystitis
  • Pyelonephritis
  • STD
  • Prostatitis
  • Diabetes
  • Syphilis, the great imitator

Initial Diagnostic Testing:

  • EKG: none
  • Labs: CBC normal with WBC = 8.9 and 79% PMN.  Chem7 normal.  UA: WBC >200/hpf, 1+ bacteria
  • Imaging: See CT scan below

QUESTIONS:

  1. What does the case image show?  (click two times to enlarge)
  2. What should you do next?  
  3. Want a 1-minute consult/tutorial on this case? 
  4. Want to know what happened with this patient?

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ANSWERS:

  1. What does the case image show?  The image shows an enlarged prostate with inflammatory changes and surrounding fat stranding.  It looks to me light there is some right sided hydronephrosis as well.  But the radiologist didn’t call that.
  2. What should you do next?  Treat with Cipro.  Consult urology.  Admit
  3. Want a 1-minute consult/tutorial on this case?  See yellow area from sample page below.
  4. Want to know what happened with this patient?  See case conclusion below tutorial page.

1-Minute EM Consult on the topic for this case from the Emergency Medicine 1-minute Consult Pocketbook

CLICK HERE TO LEAR MORE ABOUT THIS BOOK

CASE CONCLUSION: Blood and urine both grew E.coli at 24 hours.

CASE LESSONS: WBC count can look normal in bacteremia.  Don’t consider WBC normal if PMN >70%

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