Have you heard of this illness?

[DwayneEMTP]

I'm curious, as I'd not heard of it, if others have. Please, please don't Google it before answering. It's not about being the macho diagnostician, but just a curiosity of mine to see if others have heard of it, as I'm told that it's not terribly uncommon.

If you recognize it, please just post a "yes", or if not, a "no" and anything else of course, but I'd be grateful if you'd not give it away to others. This isn't really a "who'dun'it" as I think that those that have seen it will recognize it, and those that haven't, won't intuitively find their way there. I know that I could have never thought my way to a diagnosis on this, not in a hundred years.

38 y/0/m presents to you with a swollen right ankle. Swelling is uniform, no discoloration. Atraumatic per assessment and history, slightly febrile to touch locally, patient is afebrile per temporal thermometer generally (tried to get a local temp, but temporal therm wouldn't read his ankle.). No s/s (signs/symptoms) cellulitis, proximal/distal anatomy uneffected. No other relevant s/s. No relevant meds, no known allergies.

Pt reports that he had diarrhea for about 4 days that ended three or four days ago, (patients may also present with current or recently resolve STD), that he now feels awesome except for this swollen joint which is painful 8/10.

Ankle is not specific to this issue. It's sometimes (Or so I'm told.) in the toes, and knees, and more rarely in the hips. Usually effects one joint only instead of being a bilat issue.

It's not gout.

It pisses me off that now that I've been exposed/educated on this that I'm confident that I've seen it dozens of times, didn't recognize it, and mistreated it. But...we do the best we can I guess..when we know better, we do better. (hopefully.)

So what do you think? Does it ring any bells?

If this thread gets any action, I'll try and come back to it in the next 24 hours or so, but I fly tomorrow morning so sometimes go a long time without internet access.

[ERDoc]

I think I know what you are talking about, but I am very curious to see if I am correct.

[MariB]

I had no idea so I did a search and so that makes me a loser. Interesting to say the least

[chbare]

I believe I know what you are talking about. The underlying problem is not uncommon but I don't want to say anything else.

[DwayneEMTP]

Mari, not a loser until you spoil the thread.

It makes me a little bit crazy that we almost always have someone that Googles the answer and then acts like it's common knowledge for a "good" provider..., "Ahh...Yeah, I've seen this, it's a Ukrainian rhythmic butt slug larva infestation. Let's see...Thinking here...Hmmm...thinking...thinking....If I remember correctly it's only seen in teenage Ukrainian trensvestite strippers exposed over long periods to drums made from the combined hides of baby seals and American Bald Eagles...Treated with PO tears of virgins, womb infused steroids and antibiotics and the drawing of a pumpkin face on each breast. Though, I could be wrong...that's just from memory." I just want to beat the shit out of them...

Doc, Chris, would you have picked it up from the history? Or through some other means? Could you have named it? (Again, not a challenge, but as I mention, I'm shocked to find that it seems many people are familiar with this (in this environment), though I've never heard of, or could have imagined it.)

[Kaisu]

oooo oooo I think I know... and I didn't google it.

[ERDoc]

I had to google a few of my differentials but looking a little more I might not be correct with what I thought, especially if we are talking about Ukrainian butt slugs. I was thinking it was more of the Kamchatkan butt slug.

[scubanurse]

I'm going to lurk this topic because I'm too stubborn to google and too brain tired/body tired right now to think it through.

[chbare]

Dwayne, if it is what I think, I've seen a few cases come through the ER. I'm not saying it is common knowledge and my suspicion may very well be incorrect. Remember, as an ER provider I may see a couple dozen people a day with a variety of problems, so these primary care issues are more likely to be appreciated by someone like me. Again, I could be completely wrong and honestly, one of the first things I would have considered would have been gout.

[DwayneEMTP]

Good points Chris...and the only thing I really considered in this patient was gout or minor, undisclosed sprain...

When I have better access I'm interested to try and understand it better..I don't understand the system relationships at all right now...But you guys can probably explain it better after we all get on the same page. I won't let this run long...