A 68-Year-Old Hospitalized Man Is Evaluated for New-Onset Leg Weakness

A 68-year-old hospitalized man is evaluated for new-onset leg weakness.  Six days ago, he was admitted to the hospital due to fever, right leg pain, and swelling.  Physical examination showed right lower extremity edema, erythema, warmth, and tenderness from the foot to the midcalf.  Leukocyte count was 16,000/mm³, and venous Doppler ultrasonography revealed patent leg veins without thrombosis.  Blood cultures grew Staphylococcus aureus.  The patient was treated with intravenous antibiotics, and his leg symptoms improved.  However, this morning he had trouble getting out of bed due to significant leg weakness.  The patient has a history of hypertension, type 2 diabetes mellitus, coronary artery disease, and systolic heart failure.  He also has chronic low back pain from a work-related injury.  The patient has had worsening mid-back pain over the last 2 days.  Temperature is 38 C (100.4 F) , blood pressure is 130/80 mm Hg, and pulse is 88/min.  Physical examination shows normal mental status and cranial nerves.  Abdominal examination reveals a suprapubic mass.  There is midline tenderness over the lower thoracic vertebral area.  Upper extremity strength is normal, but he is not able to lift either lower extremity against gravity.  Which of the following is the best next step in management of this patient?

A) Contrast-enhanced head CT scan
B) CT scan of the abdomen
C) Echocardiography
D) Lumbar puncture
E) MRI of the spine
F) Nerve conduction study
G) Tagged leukocyte scan

Correct Answer:

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