Differential Diagnosis
- Single most likely diagnosis
- Chronic musculoskeletal back pain: The patient's complaint of back pain, combined with a history of COPD and vaping, suggests a possible musculoskeletal origin, especially given the lack of acute findings on chest and abdomen X-rays.
- Other Likely diagnoses
- Acute bronchitis or exacerbation of COPD: The patient's history of COPD, shortness of breath (SOB), and vaping habit make an exacerbation of COPD or acute bronchitis a plausible diagnosis, despite the lack of specific findings on the chest X-ray.
- Urinary tract infection (UTI): Although the urinalysis shows only a few bacteria and trace leukocyte esterase, the presence of WBCs (6-10/hpf) and RBCs (3-5/hpf) in the urine could indicate a mild or early UTI.
- Chronic kidney disease (CKD): The elevated creatinine level (1.53) and decreased eGFR (46) suggest CKD, which could be contributing to the patient's back pain and other symptoms.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pneumonia: Despite the negative chest X-ray, pneumonia should be considered, especially in a patient with COPD and SOB, as it can be life-threatening if not promptly treated.
- Pulmonary embolism (PE): Although less likely, PE is a critical diagnosis to consider in a patient with SOB, as it can be fatal if not recognized and treated promptly.
- Spinal infection or osteomyelitis: Infection of the spine or vertebrae could present with back pain and should be considered, especially if the patient has risk factors such as immunocompromised status or recent instrumentation.
- Rare diagnoses
- Multiple myeloma: The presence of back pain, anemia (although mild), and renal impairment could suggest multiple myeloma, although this would be a less common diagnosis.
- Sarcoidosis: This condition can cause back pain, renal impairment, and pulmonary symptoms, although it would be a less likely diagnosis without additional supporting evidence.