A 70-year-old male presents with severe back pain and fever. He has a history of poorly controlled gout and type 2 diabetes. His temperature is 38.5°C (101.3°F) and examination reveals tenderness in his lumbar spine. What are the potential diagnoses, and what are the next steps?
This presentation is concerning for possible spinal infection, such as vertebral osteomyelitis or discitis, particularly given the patient's history of poorly controlled diabetes. However, one must also consider a gouty attack in the intervertebral joints, although this is relatively rare. The next steps should involve urgent imaging, likely starting with an MRI of the spine if possible. Blood cultures and inflammatory markers (like C-reactive protein and erythrocyte sedimentation rate) should be obtained, and the patient should likely be started on empirical antibiotics until infection can be ruled out.