07-15-2009, 09:53 PM
A 28-year-old man who underwent renal transplantation 1 year ago is evaluated because of a 5-week history of back pain. The pain is present at all times, even at rest, but is particularly severe with any jarring motion of the spine, such as riding his bike over a bumpy surface. The patient does not have fever, lower extremity numbness, muscle weakness, or difficulty urinating. He continues to take combination immunosuppressive therapy for the kidney transplant.
On physical examination, temperature is 37.1 °C (98.8 °F); other vital signs are also normal. Palpation of the spine reveals localized tenderness and muscle spasm at the upper lumbar spine. Neurologic examination, including reflexes, sensation, and motor strength of the lower extremities, is normal.
A radiograph of the lumbar spine shows demineralization of the endplates and loss of definition of the anterior aspect of the bony L1“L2 margin. Tuberculin skin testing using intermediate-strength purified protein derivative shows 7 mm of induration. A chest radiograph is normal.
Which of the following diagnostic studies should be done next?
A CT-guided needle biopsy of the spinal lesion
B CT scan of the chest
C MRI of the entire spine
D Serum protein electrophoresis and urine immunoelectrophoresis
E Testicular ultrasonography and whole-body positron emission tomography
On physical examination, temperature is 37.1 °C (98.8 °F); other vital signs are also normal. Palpation of the spine reveals localized tenderness and muscle spasm at the upper lumbar spine. Neurologic examination, including reflexes, sensation, and motor strength of the lower extremities, is normal.
A radiograph of the lumbar spine shows demineralization of the endplates and loss of definition of the anterior aspect of the bony L1“L2 margin. Tuberculin skin testing using intermediate-strength purified protein derivative shows 7 mm of induration. A chest radiograph is normal.
Which of the following diagnostic studies should be done next?
A CT-guided needle biopsy of the spinal lesion
B CT scan of the chest
C MRI of the entire spine
D Serum protein electrophoresis and urine immunoelectrophoresis
E Testicular ultrasonography and whole-body positron emission tomography