A clerk with back pain
A 43-year-old clerk presented with generalized weakness, malaise, fever, and sweating for several weeks duration. Other symptoms included non-productive cough and backache for a few weeks duration. There was no history of morning stiffness, neither was there any history of any trauma. He had a history of diabetes mellitus for 10 years. He had a history of 40 pack years of smoking. On examination, the temperature was 37.5°C. The patient was a bit pale. There was no lymphadenopathy. Lungs were clear and the heart rate was regular, with no murmur. The abdomen was soft, with no organomegaly or tenderness noted, and pedal edema was absent. Neurological examination revealed no focal motor weakness. The reflexes were equal bilaterally and Babinski's reflex was absent. He had mild kyphosis and spinal movements were full. There was no spinal tenderness. Full blood count showed haemoglobin (Hb) 10gm%, white blood cell (WBC) was within normal limit but there was relative lymphocytosis. Electrolytes, blood urea nitrogen (BUN), creatinine, albumin were normal. The alkaline phosphatase was slightly high. Other liver enzymes were within normal limit. Erythrocyte sedimentation rate (ESR) was 82 mm/h. (copied from article).
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