Called for consult on 23 yo G3 P1 s/p SVD with CLE (multiple attempts per chart) now c/o of HA . Determining that is is a PDPHA, 24 hours of conservative management attempted, which failed. An EBP is performed with + resolution of the HA w/i 60 min. I noted CLE placed at L3/4 - so injected 20 ml at L4/5.

24 hours later, spontaneous return of HA with increased intensity. Another failed trial of conservative management and a 2nd EBP performed. 6 hours later, return of HA with low grade fever overnight but not febrile at time of 3rd consult.

What are your differentials (what do look for & chart), how many times are you going to try to patch, at what point do you refer out?