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4?ng/mL (0.0�C0.3?ng/mL). (A hydroxyprogesterone under 2?ng/mL and a testosterone that is not substantially higher than normal make congenital adrenal hyperplasia unlikely. However, the body odor suggested testing). The luteinizing hormone level of 2.0?mU/mL was consistent Cofactor with CPP (diagnostic criteria is LH > 0.3?mU/mL). Follicle stimulating hormone was elevated at 4.5?mU/mL (0.0�C4.0?mU/mL in prepubescent females) and estradiol 17B was also in the pubertal range at 39?pg/mL (selleck compound The patient tolerated the injection well, and she returned for a second injection Everolimus in three months in the same location in her right thigh. At the time, the patient appeared to tolerate this injection well also. However, three weeks after the second injection, the patient had an appointment with a pediatric orthopedic surgeon. The reason for the visit was a lump on and swelling of her right thigh at the injection site. The lump measured 5 �� 5?cm and was not tender to palpation. She reports pain in her right leg and trouble walking. She rated the pain as a 5 on a 0 to 10 scale with daily activities and with exercise. Her knee flexion was only fifteen degrees. Her right extremity showed no deformity. Ultrasound revealed no cellulitis or abnormal fluid collection at the injection site on her right thigh (see Figure 2). The lack of fluid indicated that this was not an abscess. She was diagnosed with muscle fibrosis based on the severe restriction of knee flexion due to lack of muscle excursion following the injection, as well as the presence of a mass at the injection site. She was instructed to have physical therapy. Figure 2 3. Discussion Muscle fibrosis and contracture following an intramuscular injection occurs most commonly in the anterior and lateral thigh [11]. Muscle fibrosis usually presents as atrophy, dimpling, reduced range of motion, and abnormal gait [12].