A 62-Year-Old Man With Worsening Shoulder Pain

Carolyn R. Lyon, MD

Disclosures

June 01, 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 62-year-old man with a history of hypertension, coronary artery disease, and hemodialysis-dependent end-stage renal disease presents to the emergency department with right shoulder pain that has been worsening over the past 2 months, with associated progressive swelling over the acromioclavicular (AC) joint (Figure 1).

Figure 1.

The patient denies any recent heavy lifting or trauma. He also denies fever, erythema, or warmth of the right shoulder. No drainage has emerged from the mass.

The patient's medications include clonidine, carvedilol, sevelamer, amlodipine/benazepril, cinacalcet, and lanthanum carbonate. His surgical history is notable for a left brachiocephalic fistula. The patient has no allergies to medications and denies any tobacco, alcohol, and illicit drug use. The family history is noncontributory.

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