Author: Jennifer Hopp, MD
Co Author #1: Vijay Jotwani, MD
Editor: David Sealy, MD
A.C. is a 22 year old Division I offensive lineman with past medical history significant for IgA nephropathy who developed painful swelling of his anterior left thigh and gross hematuria. The patient notes the swelling and redness of his left thigh had developed one day ago, and his urine had been progressively darkening over the past five days. His only medications include Zyrtec, fish oil 1gm, multi-vitamin, and losartan 25mg. Review of systems is positive for dry cough and rhinorrhea. He denies fever, chills, abdominal pain, headache, blurred vision, SOB, DOE, sore throat, and he has had no recent illnesses or foreign travel. He denies the use of supplements, tobacco, alcohol, or illicit drugs. He is allergic to PCN and avoids NSAIDs.
A.C. was diagnosed with IgA nephropathy seventeen months prior to this presentation, near the end of his sophomore year of football. At that time, he was admitted to the hospital for a pilonidal cyst and developed gross hematuria. Renal biopsy 6 weeks later confirmed his diagnosis. He is currently in CKD, Stage II with a baseline creatinine of 1.3 - 1.5.
Vital Signs: Temp 98.1°F BP 171/84 HR 84 RR 16 SaO2 99% on RA
Gen: White male, in no acute distress
CV: RRR, no murmurs, gallops or rubs. Palpable distal pulses.
Pulm: CTAB, no rhonchi or rales
Back: No CVA tenderness
Abd: Normal BS, no tenderness no guarding
Extr: L leg held in extension; 1+ pitting edema from hip to mid-calf; painful to touch
Skin: Erythematous macule over anterior L thigh, extending from medial thigh to knee. No pustules or vesicles. Warm to touch. No visible breaks in the skin
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