A 42-Year-Old Man With Backache and Fatigue After a Divorce

Ankit Raiyani, MBBS, MD, DNB (Hematology); Vikramjit Kanwar, MBBS, MBA, MRCP(UK)

Disclosures

July 09, 2020

Editor's Note:
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.

Background

A 42-year-old businessman describes fatigue over the past 6 months, after a divorce. He also reports intermittent low back pain, which has been relieved by over-the-counter ibuprofen. He reports that he has otherwise been in generally good health and attributed his symptoms to depression, for which he has been seeing a therapist.

He takes over-the-counter vitamin supplements but no prescription medications, including antidepressants. His travel history is significant only for a trip to the Bahamas with his new girlfriend 1 month ago. He explains that since his trip, his backache worsened. It is now waking him up at night. Sometimes, when he wakes, he feels feverish and sweaty. He reports that he has also lost a "few pounds" of weight. Concerned by these symptoms, his girlfriend persuaded him to consult a physician.

The patient's pain is confined to his lower back and is not relieved by heat or by rest. He does not have any other bone aches or pains or any joint pain or swelling. He has no significant history of rashes or bruising. He does not describe a cough, wheeze, chest pain, hoarseness, shortness of breath, or other respiratory symptoms. The patient quit smoking 4 years ago after an episode of severe pneumonia. He consumes alcohol in moderation and denies using recreational drugs.

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