Abstract
A 20-year-old man presented to the emergency department with acute dyspnea. He had history of pain and swelling on his right thigh of at least 6 months of duration accompanied by fever and weight loss of 15 kg. A previous filaria test performed in a hospital in Guinea was negative. On examination, the respiratory rate was 26 breaths per minute and the oxygen saturation 88% with jugular venous distension and rales in both lungs. As shown in Fig. 1, a soft tissuemass, large and tender to palpationwas present in the right leg extending from the pelvis to the knee (Panel A). A blood chemical profile showed alkaline phosphatase of 674 IU per liter, lactate dehydrogenase of 2611 IU per liter and a C-reactive protein level of 11 mg per liter. Computed tomography revealed a destructive permeative lesion in the femoral shaft with spiculated periosteal reaction associated with a large soft tissue mass with areas of ossification (Panel B) and subacute bilateral pulmonary embolism (Panel C, arrows) as well as multiple nodules in both lungs (Panel D).
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