A 28-Year-Old Soccer Player With Odd Abdominal Pain, Fatigue

Thomas D. Pinkney, MB ChB; Simon F. Hobbs, MB ChB; Timothy D. Stone, MB ChB; Tim C.F. Sykes, MD, BSc, MB BCh, FRCS

Disclosures

August 09, 2021

Physical Examination and Workup

Upon physical examination, the patient appears mildly dehydrated, with sunken eyes and decreased skin turgor. Vital signs demonstrate an oral temperature of 100.6ºF (38.11ºC), pulse of 90 beats/min, blood pressure of 121/65 mm Hg, respiration rate of 20 breaths/min, and oxygen saturation of 98% while breathing room air. The abdomen is soft and nondistended, and active bowel sounds are present. Significant tenderness to palpation is noted in the lower abdomen; it is most prominent in the left iliac fossa and suprapubic regions, where localized rebound and guarding are present. No organomegaly or hernias are noted. The remainder of the physical examination findings, including cardiac, respiratory, and neurologic examination, are normal.

A peripheral intravenous line is placed, and blood is drawn and sent for laboratory testing. Abdominal and upright chest radiographs are obtained. Laboratory tests are significant for a white blood cell count of 15.0 × 103 cells/μL (reference range, 3.5-12.5 × 103 cells/μL) and a C-reactive protein level of 212 mg/L (reference range, 0.08-3.1 mg/L). The rest of his laboratory test results are within normal limits, and both the abdominal and chest radiographic examinations are normal.

Urine dipstick testing does not demonstrate any blood or leukocyte esterase. CT of the abdomen and pelvis is performed, which demonstrates an area of inflammation deep to the pubic symphysis. MRI of the pelvis is obtained (Figure).

At this time, blood cultures obtained on admission return positive for Staphylococcus aureus.

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