Endocrine Case Report: Buttock Pain

Our latest emergency department quiz from Brady Pregerson, MD, features a woman in her 40’s presenting with 3 days of generalized malaise and worsening left buttock pain with subjective fevers. Check out the CT and see if you can determine the correct diagnosis.

History: A female in her 40’s presents to the hospital for 3 days of generalized malaise and worsening left buttock pain with subjective fevers. She denies any abdominal pain but did vomit once. She denies chills, back pain or any other complaints.

Exam: Vital signs were a bit soft: pulse 102, BP 92/51 with a shock index >1.0 (HR/SBP). Physical exam was otherwise normal except for a red swollen left buttock

Testing:

· WBC = 17.2 with 16 bands.

· Lactic acid = 2.6

· CT: See image below

What is the most likely diagnosis?