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Image of the Month—Quiz case
Joy Garg, MD;
Omid Reza Bakhtar, MD;
Sonia Ramamoorthy, MD
Arch Surg. 2007;142(5):487.
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INTRODUCTION
A 66-year-old man originally from the Philippines with a history of amyotrophic lateral sclerosis came to our emergency ward with suprapubic pain localizing to the right lower quadrant, a low-grade fever (temperature, 38.1°C), and tachycardia (heart rate, >100 beats/min). Initially, he was minimally communicative and dependent on a gastrostomy tube for his feedings. Given the debilitation from his neurologic disease, a broad workup including laboratory and radiologic studies was initiated. His chemistry panel, urinalysis, and blood culture results were normal. His liver enzyme panel revealed a mildly elevated total bilirubin level of 22 µmol/L (1.3 mg/dL). His white blood cell count was mildly elevated at 10 300 cells/mL. He had a left shift with 83 neutrophils, bandemia (14%), and no eosinophils. His radiologic workup revealed a normal abdominal series. A computed tomographic scan was performed, demonstrating a hyperemic appendix and pericecal . . . [Full Text of this Article]
What Is the Diagnosis?
Author Affiliations: Departments of Surgery (Drs Garg and Ramamoorthy) and Pathology (Dr Bakhtar), University of California, San Diego.
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