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Short answer question case series: a case of total body pain
  1. Daniel Normansell1,
  2. Preeti Dalawari1,
  3. Timothy Jang2
  1. 1Division of Emergency Medicine, St Louis University School of Medicine, St Louis, Missouri, USA
  2. 2Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California, USA
  1. Correspondence to Dr Timothy Jang, Department of Emergency Medicine, Harbor-UCLA Medical Center, 1000 W. Carson St., Torrance, CA 90509, USA; tbj{at}ucla.edu

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A middle-aged male with sickle β thalassaemia presents to the emergency department with increasing joint, abdominal and back pain with fatigue and intermittent fevers, nausea and vomiting for 1 week. Vital signs included a pulse of 99 beats/min, BP of 144/82 mm Hg, RR of 16 times/min, a pulse oximetry of 100% on room air, and temperature of 37.0. On physical exam, he had mild, diffuse abdominal pain with a normal motor-sensory exam of the lower extremities but increased left hip pain on extension of left leg. He kept his knees and hips in a flexed position. Labs revealed a normal leukocyte count, haemoglobin and reticulocyte count.

Key questions

  1. What are the concerning historical and physical exam findings?

  2. What imaging should be considered?

  3. What does the CT (figure 1) demonstrate?

  4. What other work-up should be obtained?

  5. How should these patients be treated?

  1. This patient does not appear to be having a vaso-occlusive crisis. Although he is afebrile and does not have a leukocytosis, he is relatively immunocompromised and may not mount …

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