Author: Shari Orenstein, MD, MPH
Co Author #1: Michael Wolf, MD
Senior Editor: Jessalynn Adam, MD
Editor: Rahul Kapur, MD
35-year-old Caucasian male with a history of cardiomyopathy with normal cardiac function and defibrillator presenting with left hip pain and systemic symptoms.
The patient presented with four weeks of nightly symptoms of fatigue, headache, and polyarthralgias. These involved bilateral ankles, wrists, fingers, toes, elbows, and the left hip. He had severe left thigh pain and chills occurring at night one to two times per month. The pain was responsive to ibuprofen.
Initial evaluation included x-ray of left femur and labs. Initial work-up did not explain the systemic symptoms and the symptoms persisted. The patient continued to take ibuprofen PRN.
One month later after the initial evaluation, an x-ray of the lumbar spine, which included the pelvis and part of the upper left femur, was obtained. The patient was diagnosed with bilateral femoroacetabular impingement and left femoral bony lesion.
In response to findings of a femoral lesion, the patient had a bone scan and MRI of the proximal left femur followed by a biopsy of the left femur performed by interventional radiology. The biopsy was reassuring. The patient underwent a left hip corticosteroid injection for femoroacetabular impingement with complete resolution of all systemic symptoms and pain within 24 hours.
Five months after the corticosteroid injection, the patient had a repeat MRI which prompted further pathological sampling.
General: well-appearing, no acute distress
Musculoskeletal: full ROM of upper extremities, 5 degrees of internal rotation and 30 degrees of external rotation of hips bilaterally without eliciting pain. No tenderness, palpable masses, or joint effusions.
Neuro: normal 5/5 strength of upper and lower extremities, 2+ patellar reflexes
Skin: no rashes or lesions
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