Level 2: Back Pain – Contrasting Case #3: Patient Information – NEED IMAGE

Given these changes from the original case, what is your diagnosis?

What is your diagnostic explanation?

As compared to the long case, this patient is a 60 year old female presenting with a complaint of low back pain. She appears to be in an extreme amount of discomfort and acutely ill.

HPI: Patient states that over the past few days she has been having low back pain. She describes the pain as sharp and located directly over her spine. She has difficulty transitioning from sitting to standing, and states that the area feels swollen. She has noticed fatigue, fevers, chills, and has been sweating profusely at night.

PMH: No known drug allergies. Simvastatin for hypercholesterolemia. Metformin for Diabetes Mellitus.

SH: 80 pack year smoking history. Occasional Alcohol. Married. Retired.

FMH: Mother had hypertension and diabetes. Father had hypertension and coronary artery disease.

ROS: Otherwise negative

PE –
VS: Height 5’5; Weight 150lb; BMI 25; HR 82; BP 140/90; RR 16; 102F
Cardiac: S1 and S2 audible. Regular rate and rhythm. No murmurs
Lungs: Clear to auscultation bilaterally. No adventitious sounds present.
Abdomen: Soft, nontender, nondistended. No organomegaly present.
Extremities: No edema present. Point tenderness over lumbar spine.

Tests: MRI of spine showing vertebral osteomyelitis