Differential Diagnosis for 44-year-old with Symptoms after Epidural Steroid Injection

• Single most likely diagnosis:
  • Cyclobenzaprine (Flexeril) side effects: The patient took Flexeril this morning and is now experiencing nausea, shakiness, and soreness, which are common side effects of this medication, especially in someone who may not be accustomed to taking it.
• Other Likely diagnoses:
  • Epidural steroid injection side effects: While less common, epidural steroid injections can cause side effects such as increased pain, nausea, and anxiety, which might be exacerbated by the injection itself or the steroid.
  • Musculoskeletal pain: The patient's description of kidney soreness could be referred pain from musculoskeletal structures, given the recent epidural injection and the presence of radiculopathy.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
  • Adrenal insufficiency: Although rare, epidural steroid injections can potentially cause adrenal insufficiency, especially if the patient has been on long-term steroids. Symptoms can include nausea, fatigue, and dizziness.
  • Infection (e.g., epidural abscess, discitis): Infections are rare but serious complications of epidural injections. Early signs might include worsening pain, fever, and systemic symptoms like nausea.
  • Allergic reaction: An allergic reaction to the steroid, anesthetic, or contrast used in the procedure could present with systemic symptoms such as nausea and shakiness.
• Rare diagnoses:
  • Kidney injury or disease: Direct kidney issues are less likely given the context but could be considered if the patient has a history of kidney disease or if symptoms persist or worsen.
  • Psychogenic causes: Anxiety or panic attacks could present with similar symptoms and might be triggered by the procedure or the anticipation of pain relief.