This endocrine case report from Brady Pregerson, MD, features a man in his 40s with a history of T1D presenting with waxing and waning right groin and inner thigh pain. Can you determine the proper diagnosis?
History of Present Illness:
A 40-ish-year-old male with a history of type 1 diabetes presents to the emergency department for 2 weeks of waxing and waning right groin & inner thigh pain that is aggravated by activity. Even at rest it is bad and he cannot sleep due to the pain.He even started using a cane for the first time in his life. He has had chills but denies any fever, injury or other complaint. He has no other past medical history and denies drug use.
Vital Signs & Physical Exam:
Vital signs are normal except for a temperature of 99.3. Physical exam is normal except for limping and pain with forced internal rotation of the hip.
Initial Diagnostic Testing:
UA: Shows hematuria without pyuria
CBC: WBC = 9.4, Hb = 12.9, plt = 519. CRP moderately elevated
BMP: glucose 316, sodium 131. Everything else normal. No anion gap
Imaging: See ultrasound below
What is the most likely diagnosis?