The Back Pain Edition: An Unusual Case of Back Pain

​BY MARK ​GRANT, DOA 31-year-old man presented to the emergency department with dyspnea, fever, cough, and weakness for two weeks. He had recently seen his internist, and was diagnosed with a viral infection. He was seen again at an urgent care center a few days before his ED presentation, and was diagnosed with bronchitis and an ear infection and placed on an antibiotic.The patient said in the ED that he was not improving, and was now experiencing back pain, shortness of breath, and occasional fevers and sweats. The patient stated he had sharp chest pain at times and was coughing up clear sputum more often over the previous few days, but had no hemoptysis, orthopnea, abdominal pain, vomiting, diarrhea, dysuria, hematuria, headache, neurologic complaints, or rashes. Physical examination revealed no otitis media or pain to palpation of the joints or spine. His lungs were clear to auscultation.The patient in the past two weeks had driven from Texas to Michigan. The patient had no history of pulmonary embolism or DVT, and had no significant past medical history. He was born in India, moved here as a child, and was up​ to date with immunizations. The patient and his family have no history of tuberculosis. His initial vital signs were blood pressure of 112/72 mm Hg, temperature of 98.7°F, pulse ox of 99% on room air, and respiratory rate of 18 bpm.An IV was established, and the patient was hydrated and labs obtained. The patient's CBC, basic metabolic panel, and urinal...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research