A 55-year-old man with fever, renal failure, and hip pain.

A 55-year-old man with diabetes mellitus was in his usual state of health until the day before admission, when he experienced severe abdominal pain that was relieved by a bowel movement several hours later. The following day, he developed excruciating right hip pain while driving. He presented to an emergency department with a temperature of 40°C (104°F) and no focal signs. He was given a dose of IV ceftriaxone. The patient was transferred to our institution for further care. The patient denied trauma to the extremity, fevers, chills, or numbness or tingling in his extremities. His medical history was significant for chronic renal insufficiency (baseline creatinine, 2.5 mg/dL) due to his type II diabetes, previous osteomyelitis, hypertension, and peripheral vascular disease with a past revascularization of the right leg.