Differential Diagnosis
- Single most likely diagnosis + C. Vertebral osteomyelitis: This is the most likely diagnosis given the patient's symptoms of worsening low back pain, night sweats, low-grade fevers, and malaise. The recent history of transurethral resection of the prostate (TURP) six weeks ago increases the risk of hematogenous spread of infection to the spine, which is a common cause of vertebral osteomyelitis. The elevated platelet count and normal leukocyte count also support an infectious or inflammatory process.
- Other Likely diagnoses + A. Vertebral compression fracture: Although less likely, a vertebral compression fracture could explain the patient's back pain, especially given his age. However, the absence of recent trauma and the presence of systemic symptoms such as night sweats and fevers make this diagnosis less likely. + B. Psoas abscess: A psoas abscess could cause back pain and systemic symptoms, but it is less likely given the lack of specific findings such as a palpable mass or significant hip pain with flexion.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.) + D. Spinal cord compression: Although the patient does not have sensory or motor deficits, spinal cord compression is a medical emergency that requires prompt diagnosis and treatment. It is essential to consider this diagnosis, even if it seems less likely, to avoid missing a potentially catastrophic condition. + Epidural abscess: Not listed among the options, but an epidural abscess is a serious and potentially life-threatening condition that could present with similar symptoms, including back pain, fever, and malaise. It is crucial to consider this diagnosis to ensure timely intervention.
- Rare diagnoses + Spinal tumors: Although rare, spinal tumors could cause back pain and systemic symptoms. However, the acute onset and presence of infectious symptoms make this diagnosis less likely. + Inflammatory spondyloarthropathies: Conditions such as ankylosing spondylitis or psoriatic spondylitis could cause back pain and systemic symptoms, but they are less likely given the patient's age and lack of other characteristic symptoms.