MKSAP: 30-year-old woman with right antecubital fossa and biceps pain

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 30-year-old woman is evaluated for a 2-day history of increasing pain in the right antecubital fossa and biceps. She reports daily injection drug use. Medical history is otherwise unremarkable, and she takes no prescription medications. On physical examination, temperature is 39.7 °C (103.5 °F), blood pressure is 90/56 mm Hg, pulse rate is 120/min, and respiration rate is 28/min. BMI is 28. She appears ill. No lymphangitis or right axillary or epitrochlear lymphadenopathy is evident. The right biceps area is extremely tender and warm, with multiple track marks, woody induration, edema, and overlying ecchymotic bullous lesions. Laboratory studies: Leukocyte count 23,000/µL (23 × 109/L) (80% neutrophils, 12% band forms, 8% lymphocytes) Aspartate aminotransferase 55 U/L Bilirubin, total 2.0 mg/dL (34.2 µmol/L) Creatinine 1.7 mg/dL (150 µmol/L) Electrolytes: Sodium 135 mEq/L (135 mmol/L) Potassium 4.2 mEq/L (4.2 mmol/L) Chloride 95 mEq/L (95 mmol/L) Bicarbonate 16 mEq/L (16 mmol/L) No gas or foreign body is seen on plain radiographs of the right arm and shoulder. In addition to emergent surgical evaluation, which of the following is the most appropriate empiric treatment? A: Ceftriaxone plus metronidazole B: Doxycycline plus ciprofloxacin C: Penicillin plus clindamycin D: Vancomycin plus piperacillin-tazobactam Continue reading ... Your...
Source: Kevin, M.D. - Medical Weblog - Category: Journals (General) Authors: Tags: Conditions Infectious disease Source Type: blogs