Differential Diagnosis for a 53-year-old Man with Severe Back Pain, Vomiting, and Fever
- Single most likely diagnosis:
- Pyelonephritis or Kidney Infection: This condition is a common cause of severe back pain (often flank pain), vomiting, and fever in adults. The presence of fever and vomiting suggests a systemic infection, and the back pain could be related to the kidneys.
- Other Likely diagnoses:
- Pneumonia: While pneumonia primarily affects the lungs, severe cases can cause upper back pain, fever, and vomiting, especially if the infection is in the upper lobes of the lungs.
- Pancreatitis: Acute pancreatitis can cause severe back pain that radiates to the abdomen, along with nausea, vomiting, and fever, making it a plausible diagnosis.
- Musculoskeletal issues (e.g., severe muscle strain or spinal disc problems): These could cause back pain but might not fully explain the systemic symptoms like fever unless there's an associated infection.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed):
- Spinal Epidural Abscess: A serious condition that requires immediate medical attention. It can cause back pain, fever, and neurological deficits. Although less common, missing this diagnosis could be catastrophic.
- Aortic Dissection: A life-threatening condition where there is a tear in the aorta's inner layer. It can cause severe, sudden back pain and might be accompanied by vomiting and fever if there's associated infection or inflammation.
- Meningitis: Inflammation of the protective membranes covering the brain and spinal cord, which can cause fever, headache, stiff neck, and back pain. It's less likely to present primarily with back pain but is critical not to miss due to its high mortality rate if untreated.
- Rare diagnoses:
- Spinal Tumors: Although rare, spinal tumors can cause back pain, and if they become infected, could lead to fever and vomiting.
- Osteomyelitis: An infection of the bone, which could cause localized back pain, fever, and systemic symptoms like vomiting if the infection becomes severe.
- Retroperitoneal Fibrosis: A rare condition where fibrotic tissue forms in the retroperitoneum, potentially causing back pain and other systemic symptoms if it compresses or invades nearby structures.