Differential Diagnosis for Acute Onset Difficulty Walking with Pain to Touch and Fever in a Patient with Hodgkin Lymphoma on Chemotherapy

• Single Most Likely Diagnosis
  • Neutropenic sepsis or infection: Given the patient's history of chemotherapy for Hodgkin lymphoma, they are likely immunocompromised, making them susceptible to infections. The acute onset of difficulty walking, pain to touch, and fever could indicate an infection such as osteomyelitis or septic arthritis, which are serious and require immediate attention.
• Other Likely Diagnoses
  • Chemotherapy-induced neuropathy: Chemotherapy agents can cause neuropathy, leading to difficulty walking and pain. However, the presence of fever might suggest an infectious component.
  • Vertebral compression fracture: Patients with cancer, especially those on chemotherapy, are at increased risk for osteoporosis and vertebral compression fractures, which could cause acute onset back pain and difficulty walking.
  • Spinal cord compression: A known complication in cancer patients, spinal cord compression can cause acute neurological deficits, including difficulty walking, and is a medical emergency.
• Do Not Miss Diagnoses
  • Spinal epidural abscess: Although less common, this condition is life-threatening and requires immediate intervention. It can present with fever, back pain, and neurological deficits such as difficulty walking.
  • Cauda equina syndrome: This is a serious condition that can result from compression of the nerves in the lower spine, leading to pain, sensory disturbances, and potentially permanent neurological damage if not promptly treated.
• Rare Diagnoses
  • Leptomeningeal metastasis: Cancer cells can spread to the meninges, causing a variety of neurological symptoms, including difficulty walking. However, this would be less likely without other signs of neurological involvement.
  • Paraneoplastic syndromes: These are rare disorders that are triggered by an altered immune system response to a neoplasm. They can cause a wide range of neurological symptoms, including difficulty walking, but are less common and would require specific diagnostic testing to confirm.