A 51-Year-Old Man With HIV and Suprapubic Pain

Jordan Burlen, BS; Umar Darr, MD; Zeinab Moussa, MD; Syed Hasan, DO

Disclosures

March 02, 2016

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case you would like to suggest for a future Case Challenge, please contact us.

Background

A 51-year-old black man with history of HIV infection resistant to tenofovir disoproxil/emtricitabine, renal stones, and recurrent urinary tract infection (UTI) presents to the emergency department with right suprapubic pain radiating to the testicles. The pain woke him about 1 hour before presentation. He describes the pain as sudden in onset, continuous and progressive, severe in intensity, and sharp and aching in character. The pain does not radiate anywhere else. He also complains of nausea, vomiting without blood, neck pain, dizziness, swollen lymph nodes, bone pain, fatigue, ischuria, and dysuria without blood.

The patient had been hospitalized 15 days ago for sepsis secondary to enterococcal infection, methicillin-resistant Staphylococcus aureus (MRSA) pyelonephritis, and urolithiasis. His medical history is also significant for benign prostatic hypertrophy, herpes zoster, and constipation. The patient was a former smoker, drinks alcohol occasionally, and lives alone. He also states that he has not been compliant with his medications, including those for his HIV infection.

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