Author: Drew Watson, MD, MS
Co Author #1: none
Editor: R. Amadeus Mason, MD
A previously healthy 14 year-old cross country runner initially developed right knee pain while at cross country camp four days prior to presentation.
Over the next three days the pain worsened and he developed daily fever, body aches, shortness of breath, pleurisy, and diarrhea. At that time he was referred to the local emergency department where he was found to have a right middle lobe pneumonia treated with azithromycin and ceftriaxone. Shortly after admission, however, he developed increasing respiratory distress and hypotension. He was fluid resuscitated, started on vancomycin, epinephrine and dopamine and emergently transferred to our facility for further management.
Vital signs: Temp: 97.7, HR: 156, BP: 78/58, RR: 47, and SaO2: 94% on 3L 100% O2. Physical exam reveals a well-developed, ill-appearing adolescent male in acute distress with intercostal retractions and crackles over his right lung fields, diffuse abdominal tenderness with guarding and hypoactive bowel sounds, 1+ distal upper and lower extremity pulses, and tenderness, warmth, redness and swelling circumferentially over his right knee and proximal right calf without discrete areas of fluctuance or induration.
Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.