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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
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What are the concerning historical and physical exam findings?
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What imaging should be considered?
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What does the CT (figure 1) demonstrate?
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What other work-up should be obtained?
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How should these patients be treated?
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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 …
Footnotes
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Contributors All authors contributed to the write-up of this case. DN and PD saw the patient initially. TJ assisted in the write-up and content.
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Competing interests None.
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Provenance and peer review Not commissioned; internally peer reviewed.