The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.
A 26-year-old man presents to his primary care provider with a 2-month history of lower back pain and stiffness. The pain is intermittent, present at night, and usually worse in the morning than it is later in the day or evening. The pain improves with activity and worsens after rest. He has also noticed a progressive inability to perform activities that require flexibility in the back, such as bending down to pull on his pants or tying his shoelaces. He reports several brief episodes of lower back pain over the previous 6 years, none lasting more than 6 weeks. He attributed these episodes to back strain.
He also reports a several-month history of low-grade fever, malaise, and anorexia, as well as an unintended weight loss of 10 lb (4.5 kg). He has not noted any masses on his testicles with self-examination.
The patient has no history of rash. He does not have any known chronic medical conditions. He takes one multivitamin per day. He has never smoked, but he does drink an occasional glass of wine with dinner. No significant family history of disease is reported.
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Cite this: Jeremy J. Logan, Gautam Dehadrai, Herbert S Diamond. A 26-Year-Old With Fever and Malaise Now Can't Tie His Shoes - Medscape - Sep 09, 2021.