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Uncovering The Spark: A Case Of Knee Pain In A Young Athlete - Page #3
 

Lab Studies:
Complete blood count: White blood cell count 13.1 x 10⁹/L, hemoglobin 13.2 g/dL, hematocrit 40.6%, and platelet count 437 x 10⁹/L. Values remained largely unchanged on serial testing.

C-reactive protein: 0.1 mg/dL.

Erythrocyte sedimentation rate: Initially 13 mm/hour, increasing to 22 mm/hour on repeat testing.

Comprehensive metabolic panel: Sodium 140 mmol/L, potassium 3.6 mmol/L, chloride 107 mmol/L, bicarbonate 25 mmol/L, blood urea nitrogen 17 mg/dL, creatinine 0.47 mg/dL, glucose 140 mg/dL, calcium 9.8 mg/dL, total protein 7.8 g/dL, albumin 4.5 g/dL, total bilirubin 0.2 mg/dL, aspartate aminotransferase 29 U/L, alanine aminotransferase 30 U/L, and alkaline phosphatase 322 U/L. Values remained largely unchanged on serial testing.

Magnesium: 2.1 mg/dL.

Phosphorus: 5.1 mg/dL.

Lactate dehydrogenase: 247 U/L.

Uric acid: 4.0 mg/dL.

Creatine kinase: 67 U/L.

Coccidioidomycosis immunoglobulin G and immunoglobulin M: Negative.

QuantiFERON-TB Gold: Negative.

Peripheral blood smear and flow cytometry: Unremarkable.

Bone marrow studies: Unremarkable, including smear, microarray, and karyotype analyses.

Femur biopsy: Culture-negative chronic inflammatory infiltrate within a fibroblastic background.

Other Studies:
Four-view radiographs of the left knee demonstrated sclerosis involving the distal femur, proximal tibia, and, to a lesser extent, the proximal fibula. Case Photo #1 Case Photo #2 Case Photo #3 Case Photo #4

Magnetic resonance imaging of the left knee with and without contrast demonstrated abnormal marrow signal within the metaphyses of the femur, tibia, and fibula with a mildly serpiginous morphology. Confluent T1 hypointense areas Case Photo #5 Case Photo #6 corresponded to T2 hyperintense areas. Case Photo #7

Whole-body magnetic resonance imaging demonstrated symmetric increased T2 signal within the bilateral distal femoral metaphyses and bilateral proximal tibial and fibular metaphyses. Case Photo #8 Case Photo #9

Consultations:
Hematology/Oncology, Rheumatology, and Interventional Radiology were consulted.

Click here to continue. Challenge yourself by writing down a revised, working diagnosis before moving to the next slide.

NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.
 

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