History: 62 y/o woman presented to the ED with progressively worsening back pain for six weeks. She remembers straining her back when she was gardening. She treated herself with motrin, but because of a planned shoulder surgery went to her PCM (knowing sheâ€™d have to stop the NSAIDs) and was switched to Percocet which seemed to help. Her shoulder surgery went well, but she notes worsening back pain ever since then especially over the last two weeks.
She went to the ED multiple times for severe pain and at least once three weeks ago she was noted to have fever of 102 as well as an elevated ESR (105). She was presumptively diagnosed with PMR and started on prednisone and referred to Rheumatology. She was seen by both family medicine and Rheumatology who agreed she likely did not have PMR and the steroids were discontinued, however she continued to have progressive lower back pain now with intermittent radicular symptoms. An MRI was ordered to be done routinely as an outpatient. She denies weakness, saddle anesthesia, fecal or urinary incontinence, rashes, joint pain, or n/v/d.
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