Abstract
Answer D. Spinal infection
Spinal infections are difficult to diagnose owing to the subtle onset of symptoms and low specificity of signs. This man has risk factors for a spinal infection. The back pain and associated fevers should raise suspicion of a spinal infection. A spinal fracture is less likely as he still has movement, there is no spinal tenderness and no history of trauma. Mechanical back pain is a possible and quite likely diagnosis, but there are features to raise suspicion of a spinal infection. The history is still acute, so myeloma would be lower on the list of differentials and there is no evidence of sciatica.
InnovAiT article: Spinal infections. DOI: 10.1177/1755738018774073.