Case of the Month 1: Presentation

by James Hassel • July 3, 2015 • 2 Comments

26 y/o M no PMH presents to the ED with c/o 1 month rectal pain and bleeding. Has been having sharp rectal pain worsened with moving bowels for about 4 weeks. Occasionally passes streaks of bright red blood or a thin purulent discharge. Feels like he has had low-grade fevers at home. Pain occasionally is felt in lower part of his abdomen. Reports that stools are mildly loose.

ROS: Negative aside from above

PMH: None

PSH: None

Meds: None

All: NKDA

SH: No toxic habits, has 1 male sexual partner

Vitals – T 100.4F, HR 88, RR 12, BP 128/77

PE negative except for:

– Mild lower abdominal tenderness without rebound or guarding

– B/l tender inguinal LAD

– Pain with DRE, small amount of bright red blood and purulent mucous on glove

For all the marbles, answer these questions:

What is your differential diagnosis? What would your workup entail? How would you treat your suspected diagnoses?

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