Differential Diagnosis
The patient presents with a complex set of symptoms including lower back pain, difficulty walking long distances, a recent episode of high fever, and a history of CAD and gout. Given the information, the differential diagnosis can be categorized as follows:
- Single Most Likely Diagnosis + Musculoskeletal back pain (e.g., strain, sprain): Given the patient's difficulty walking long distances and the presence of lower back pain, musculoskeletal issues are a common cause of such symptoms. The recent episode of high fever could be related to a viral illness or another cause that was not identified during the ER visit.
- Other Likely Diagnoses + Gout flare: The patient's history of gout and current symptoms of difficulty walking could suggest a gout flare, especially if the back pain is localized to a joint area commonly affected by gout. + Urinary Tract Infection (UTI): Although the ER evaluation was reported as normal, UTIs can sometimes present with non-specific symptoms such as fever and back pain, especially in older adults. + Degenerative disc disease or spinal stenosis: These conditions could explain the patient's difficulty walking long distances due to back pain.
- Do Not Miss Diagnoses + Spinal infection (e.g., discitis, osteomyelitis): Although less common, spinal infections can present with back pain and fever. Given the patient's recent episode of high fever, this diagnosis must be considered, especially if there's a failure to improve with current treatment. + Vascular events (e.g., aortic dissection): Given the patient's history of CAD, a vascular event such as an aortic dissection could present with back pain and should be considered, especially if there are any associated symptoms like severe, tearing chest pain. + Kidney stones: While the ER evaluation was normal, kidney stones could cause severe back pain and fever if there's an associated infection.
- Rare Diagnoses + Inflammatory back pain (e.g., ankylosing spondylitis): Although less likely given the patient's age and presentation, inflammatory causes of back pain should be considered if other diagnoses are ruled out. + Malignancy (e.g., metastatic disease to the spine): Given the patient's age and the presence of back pain, although rare, a malignancy affecting the spine could be a consideration if other diagnoses are excluded and the patient fails to improve.
Each of these diagnoses should be considered in the context of the patient's full history, physical examination, and diagnostic testing to determine the most appropriate diagnosis and treatment plan.