title: An occult presentation of appendicitis in a patient with tetraplegia.
abstract: A 26-yr-old man with a C4 American Spinal Injury Association impairment scale B spinal cord injury was admitted due to a left calf pressure ulcer. The patient's initial laboratory results and physical examination findings were unremarkable, except for a stage IV pressure ulcer. On day 7, the patient developed fever and leukocytosis. A complete culture workup performed did not yield abnormalities. A computed tomography scan of the abdomen and pelvis revealed retrocecal appendicitis with a retrocecal abscess containing an appendicolith. The abscess was drained percutaneously, and the patient was given a 6-wk course of intravenous antibiotics. The patient returned to the hospital 30 days later for an appendectomy. Typical signs of appendicitis can be masked in patients with a spinal cord injury. It is crucial to include appendicitis in the differential diagnosis of this population, even though the presentation is as nonspecific as fever and leukocytosis.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Tufts Medical Center, Boston, Massachusetts 02111, USA.
authors.forename: Jason L
authors.initials: JL
authors.lastname: Zaremski
authors.forename: Vidya
authors.initials: V
authors.lastname: Jayawardena
authors.forename: Henry L
authors.initials: HL
authors.lastname: Lew
mesh_terms: D001064:Appendicitis / Q000150:complications / Q000000981:diagnostic imaging*; D005334:Fever / Q000209:etiology; D006801:Humans; D007964:Leukocytosis / Q000209:etiology; D008297:Male; D003668:Pressure Ulcer / Q000628:therapy; D011782:Quadriplegia / Q000150:complications*; D014057:Tomography, X-Ray Computed; D055815:Young Adult