Differential Diagnosis for Back Pain in a 14-year-old Boy
Single most likely diagnosis
- D. Osteoid osteoma: This is a benign bone tumor that commonly presents with nocturnal pain that is relieved by nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen. The patient's symptoms of dull, nonradiating back pain in the midthoracic spine region that worsens at night and is promptly relieved by ibuprofen are characteristic of osteoid osteoma.
Other Likely diagnoses
- E. Spondylolysis: This refers to a defect in the pars interarticularis of the spine, often due to repetitive stress. Although the patient does not participate in sports, spondylolysis can still occur. However, the lack of activity-related pain and normal range of motion make this less likely.
- B. Disc herniation: While less common in adolescents, disc herniation can occur and present with back pain. However, the absence of radiating pain, paravertebral spasm, or localized tenderness makes this diagnosis less likely.
Do Not Miss
- Infection (e.g., osteomyelitis or discitis): Although the patient does not have fever, warmth, or erythema, infections can sometimes present subtly, especially in the early stages. It is crucial to consider these diagnoses due to their potential severity and need for prompt treatment.
- Tumor (e.g., Ewing's sarcoma): While rare, malignant tumors can cause back pain in adolescents. The night pain and relief with NSAIDs could also be seen in malignant processes, making it essential to rule out these conditions.
Rare diagnoses
- A. Ankylosing spondylitis: This chronic inflammatory disease is more common in older adolescents and young adults, typically presenting with morning stiffness and improvement with activity. The patient's age and lack of morning stiffness make this diagnosis less likely.
- C. Lumbosacral strain: Given the patient's lack of sports participation and absence of a recalled injury, this diagnosis is less plausible, especially since the pain is in the midthoracic region rather than the lumbosacral area.