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LEARNING OBJECTIVES

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After completing this case study, the reader should be able to:

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  • Describe the most common presenting signs and symptoms of osteomyelitis and septic arthritis.

  • Recommend an antimicrobial treatment plan with empiric and definitive therapy for osteomyelitis and septic arthritis.

  • Develop alternative treatment approaches for osteomyelitis and septic arthritis when the preferred regimen cannot be used.

  • Create monitoring parameters to evaluate the efficacy and toxicity of antimicrobial therapy for osteomyelitis and septic arthritis.

  • Provide patient education on the proper administration of home infusion antibiotics for osteomyelitis and septic arthritis.

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PATIENT PRESENTATION

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Chief Complaint

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“Back spasms.”

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HPI

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Richard Frost is a 52-year-old male with a history of chronic back pain who presents with a 1-week history of back spasms localized in the thoracic region. He was doing relatively well until 1 week ago when he went bowling and also did some maintenance around his house, whereupon his back felt tight. There is radiation of pain to his upper right leg with movement. He had a similar episode three months ago that resolved after approximately 2 days with no treatment. He reports this episode to be more severe. He denies nausea, vomiting, fevers, chills, chest pain, shortness of breath, and bowel or bladder incontinence. He reports decreased oral intake over the past week due to pain and general malaise.

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PMH

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Patient reports chronic back pain starting approximately 10 years ago. He does not routinely seek medical care and does not report any chronic conditions.

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FH

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Noncontributory

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SH

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He has smoked one pack of cigarettes per day for the past 20 years. He admits to IV heroin use for the past 3–4 years.

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Meds

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Acetaminophen and ibuprofen as needed for back pain; he has increased use of these medications over the past week

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All

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No known allergies

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ROS

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No positive findings with regard to head, eyes, ears, nose, throat; cardiorespiratory systems; or recent illness. Skin lesion noted as discussed below. No other significant trauma.

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Physical Examination

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Gen
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He does not appear to be in any acute distress

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VS
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BP 152/109, P 84 bpm, RR 18, T 36.4°C; 96% SpO2 on room air, Ht 5′8″, Wt 90 kg

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Skin
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Open left lateral leg ulcer 4 × 2 in in size with foul-smelling, purulent drainage. Patient reports this ulcer to be a result of burning his leg on a motorcycle approximately 1 year previously. He has not previously sought medical care for this condition.

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HEENT
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