Fever
Questions
167.A 43-year-old man, who currently uses drugs intravenously (IV), pre-
sents to the emergency department (ED) with 2 weeks of fever, back pain,
and progressive weakness in his arms bilaterally. He reports having a cough
with whitish sputum. He denies any history of recent trauma. His blood
pressure (BP) is 130/75 mm Hg, heart rate (HR) is 106 beats per minute,
temperature is 103°F, and respiratory rate (RR) is 16 breaths per minute. On
physical examination, he has tenderness to palpation in the mid-thoracic
spine, and decreased strength in the upper extremities bilaterally, with nor-
mal range of motion. Laboratory results reveal a white blood cell (WBC)
count of 15,500/μL, hematocrit 40%, and platelets 225/μL. Which of the
following is the most likely diagnosis?
a. Lung abscess
b. Ankylosing spondylitis
c. Spinal epidural abscess
d. Vertebral compression fracture
e. Spinal metastatic lesion
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