A 26-Year-Old With Fever and Malaise Now Can't Tie His Shoes

Jeremy J. Logan, MD; Gautam Dehadrai, MD;  Herbert S Diamond, MD

Disclosures

September 09, 2021

Physical Examination and Workup

Upon physical examination, the patient has a blood pressure of 125/67 mm Hg and a heart rate of 60 beats/min. His respiratory rate is 8 breaths/min and his temperature is normal at 98°F (36.7°C). His cardiovascular and respiratory findings are normal; specifically, no murmurs or rubs are detected. The patient has no photophobia, eye redness, or decreased visual acuity.

Upon examination of the back, flexion of the lumbar spine is clearly decreased when the patient attempts to bend down to touch his toes. He also has pain and limited range of motion with rotation and lateral flexion at the lumbar spine. His chest expansion is mildly diminished. The remainder of the physical examination is within normal limits.

As part of the initial workup of the findings on physical examination, routine laboratory investigations, including a complete blood cell (CBC) count and a basic electrolyte panel, and plain radiographs of the back are performed. The chemistry panel is unremarkable, and the CBC reveals a white blood cell count of 4.6 × 103 cells/μL (reference range, 4.5-11 × 103 cells/μL), a hemoglobin level of 13.7 g/dL (reference range, 13.5-17.5 g/dL), a hematocrit of 43% (reference range, 41% to 50%), and a platelet count of 120 × 103 cells/μL μL (reference range, 150-450 × 103 cells/μL). Electrolyte values are within normal limits.

A rheumatoid factor test results are negative, and the erythrocyte sedimentation rate is 64 mm/hr (reference range, < 10 mm/h). The patient has a positive finding for human leukocyte antigen (HLA)-B27.

Anteroposterior and lateral radiographs of the lumbar spine are obtained (Figures 1-2).

Figure 1.

Figure 2.

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