I-Ta Tsai Intern, National Yang-Ming University Case Presentation

General Data 49-year-old male 板模工人

Chief Complaint Progressive upper back pain for 3 days

Right shoulder & knee pain and swelling Synovial fluid Cold sweating Weight ↓ 12 kg Oral ulcer Septic arthritis RA ? Prednisolone Celecoxib Plaquenil Methotrexate Salazopyrin

Bacteremia (OSSA) Echocardiography: (-) Abdominal CT: abscesses Lower limbs weakness Spine MRI Drainage Moxifloxacin Epidural abscesses T5-T8, L1-L3, & L3-S1 Laminectomies Culture: K. pneumoniae, ESBL Ertapenem

Fever & dyspnea BCx: GPC Oxacillin Skin eruption Vancomycin OSSA Drug allergy ? TEE: (-)

Upper back pain Numbness, tingling pain to ant. chest Tenderness at T spine area Osteomyelitis Residual epidural abscess

Personal History Heavy smoker Alcoholism No HTN/DM/hepatitis Herbs: black pills

Past History Hemorrhoid COPD Operation: Laminectomy

Allergy History Oxaillin, urticaria-like No food/transfusion allergy

Family History No IMRH family history

Review of System No fever/chills, skin rash No nuchal stiffness/pain No cough No heel pain Numbness, no weakness

Review of System No Raynaud's phenomenon No erythema nodosum No petechia/purpura No incontinence

Physical Examination Normal skin turgor, no rash No oral ulcer No neck stiffness Clear breath sounds Abd: soft, no tenderness

Physical Examination Vertebral knocking pain No petechia No Osler's node No rheumatoid nodule Abnormal spine movement

Impression Chronic osteomyelitis Residual prevertebral abscess

Hospitalization BCx: OSSA Osteomyelitis scan: (-) MRI: T 7-8 spondylodiscitis with disc buldging NS: no surgery CM: suggest HBO

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