Skin Changes, Back Pain and Fever: An Unexpected Diagnosis

Shing Ching, MBBS; Ka Hing Lee, MBChB, FHKAM; Kai Ming Li, MBBS, MRCP, FHKAM

September 18, 2015
 

A 78-year-old woman was in her usual state of health until she developed severe lower back pain and low-grade fever for 2 weeks. Physical examination was notable for exquisite tenderness of the lower spine. Her lips and palms are shown (figure 1). No focal neurologic deficit was present. Contrast computer tomography of abdomen and spine showed bilaterally enlarged adrenal glands, an enhancing mass eroding the pedicles of T11 vertebra encroaching on the spinal cord (figure 2), and dilated common bile duct.

References: 

1. Neary, N. and L. Nieman, Adrenal insufficiency: etiology, diagnosis and treatment. Curr Opin Endocrinol Diabetes Obes, 2010. 17(3): p. 217-23.
2. Spectrum of CT findings in nonmalignant disease of the adrenal gland. RadioGraphics, 1998. 18(2): p. 393-412.
3. Levy, N.T., et al., Adrenal insufficiency as a manifestation of disseminated non-Hodgkin's lymphoma. Mayo Clin Proc, 1997. 72(9): p. 818-22.

Author biography:

Shing Ching is a resident in the Department of Accident and Emergency at United Christian Hospital, Hong Kong. He attended medical school at the University of Hong Kong.

Ka Hing Lee is an associate consultant in the Department of Accident and Emergency at United Christian Hospital, Hong Kong. He attended medical school at the Chinese University of Hong Kong and completed his emergency medicine residency and fellowship at the same hospital.

Kai Ming Li is the head of Department of Accident and Emergency at United Christian Hospital, Hong Kong. He attended medical school at the University of Hong Kong, completed residency and fellowship in internal and emergency medicine at the same hospital