Case Presentation

A 53 year old white male with a past medical history significant for type II diabetes mellitus and orthotopic liver transplant (December 2006) secondary to hepatitis B cirrhosis presents as a direct admission to Thomas Jefferson University Hospital in September 2007 for an orthopedic preoperative risk evaluation. Patient has had a dull, worsening, non-radiating back pain of six months duration, beginning after his liver transplant for which he has been to several outpatient orthopedic physicians. Upon admission, the patient appeared well, but admitted to a consistent 8/10 back pain that he had been managing at home with narcotic medications. Of note, outpatient magnetic resonance imaging (MRI) showed diskitis at L4/L5. Spinal biopsy and cultures were performed to rule out cord compression, spinal injury and infection due to his previous surgery and were all negative. On review of systems, he denied any lower extremity tenderness, numbness, paresthesias or loss of bowel or bladder function. He has lost over 70 pounds since his liver transplant. The remainder of the patient’s past medical history was negative except for a history of cataracts due to his diabetes mellitus. He reports a strong family history of hypertension, coronary artery disease and both type I and type II diabetes mellitus.