internal medicine
Morbidly obese 75-year old with diabetes mellitus
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A 62-year-old man with history of type 2 diabetes mellitus requiring insulin presents after returning from a trip to Colombia.
Two weeks before hospital admission the patient developed daily fevers, diminished appetite, diffuse myalgias, mild shortness of breath, headache, and backache. Two days before admission he developed pain in the right thigh. On examination, the patient was febrile, tachycardic, and exhausted. The examination of his lungs, heart, and abdomen was unrevealing. His right thigh was tender to touch, although there was no frank erythema or swelling.
The patient’s white cell count was 20.6 × 109 cells/L, hemoglobin 10.6 mg/dL, glucose 323 mg/dL, sedimentation rate 100 mm/hour, and creatine kinase 745 U/L. Magnetic resonance imaging showed fluid collection affecting the vastus lateralis muscle (see figure).
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Figure.
The most likely cause of this infection is which of the following?
- Streptococcus pneumoniae
- Salmonella species
- Streptococcus anginosus
- Staphylococcus aureus
- Anaerobes
This question appears in Med-Challenger Family Nurse Practitioner Exam Review with CME
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