Differential Diagnosis

• Single most likely diagnosis
  • Spinal epidural abscess: This diagnosis is highly likely given the patient's recent history of spinal surgery (cervicothoracic decompression and fusion, and laminectomy for resection of epidural mass infection), progressive upper back pain, weakness, numbness ascending from the feet, and recent history of IV drug abuse. The patient's symptoms of sweating, chills, and weight loss also suggest an infectious process.
• Other Likely diagnoses
  • Spinal cord compression or injury: Given the patient's history of neurogenic bladder and recent spinal surgeries, it is possible that there is ongoing compression or injury to the spinal cord, which could explain the patient's progressive weakness, numbness, and loss of bowel sensation.
  • Osteomyelitis or discitis: The patient's recent spinal surgeries and history of IV drug abuse increase the risk of osteomyelitis or discitis, which could cause the patient's upper back pain, fever, chills, and weight loss.
  • Metastatic spinal cord compression: Although less likely, given the patient's history of IV drug abuse and recent weight loss, it is possible that the patient has an underlying malignancy that is compressing the spinal cord.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Spinal hematoma: Given the patient's recent spinal surgeries, it is possible that there is a spinal hematoma that is compressing the spinal cord, which would require urgent surgical intervention.
  • Meningitis: Although less likely, given the patient's symptoms of fever, chills, and sweating, it is possible that the patient has meningitis, which would require prompt antibiotic treatment.
  • Cauda equina syndrome: This is a medical emergency that requires urgent surgical intervention, and it is possible that the patient's symptoms of progressive weakness, numbness, and loss of bowel sensation could be due to cauda equina syndrome.
• Rare diagnoses
  • Spinal arteriovenous malformation (AVM): Although rare, it is possible that the patient has a spinal AVM that is causing the patient's symptoms of progressive weakness, numbness, and loss of bowel sensation.
  • Spinal cord infarction: This is a rare diagnosis, but it is possible that the patient has had a spinal cord infarction, which could explain the patient's symptoms of progressive weakness, numbness, and loss of bowel sensation.