A full neurologic examination, including straight leg raise, is normal. Laboratory results are as follows:

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#1

32-year-old man comes to the clinic due to a week of escalating low back pain. The pain is dull, achy, present at rest, and worse with activity.

The patient has no significant medical history. He smokes a pack of cigarettes daily and drinks alcohol occasionally. He recently began using

intravenous heroin due to significant psychosocial stress at home. There is a family history of prostate cancer in his father. Temperature is 36.7 C

(98 F), blood pressure is 120/80 mm Hg, pulse is 90/min, and respirations are 16/min. Gentle percussion over the lumbar vertebrae (L3 and L4)

elicits exquisite pain. A full neurologic examination, including straight leg raise, is normal. Laboratory results are as follows:

Complete blood count

Hematocrit 46%

Platelets 550,000/mm3

Leukocytes 8,500/mm3

Which of the following is the most likely diagnosis?

  • QA Ankylosing spondylitis
  • 0 B. Lumbar disk herniation
  • 0 C . Lumbar spinal stenosis
  • 0 D. Prostate cancer
  • 0 E. Vertebral compression fracture
  • 0 F Vertebral osteomyelitis

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