History of Presentation
A 68-year-old male with a past medical history of hypertension but not compliant with medication presented to emergency department (E.D.) with complaints of back and abdominal for the past 2 months. The patient described the pain as dull, localized to the paraspinal region, non-radiating, with no aggravating factors, and partially relieved on taking ibuprofen. He also noticed having unintentional weight loss and excessive fatigue for the past year. His pain worsened, prompting him to come to the E.D. He denies having fever, chills, night sweats, chest pain, nausea, vomiting, diarrhea, constipation, or a history of cancer.
On examination, his vital signs were recorded as; blood pressure (B.P.) of 223/135 mmHg, a heart rate (H.R.) of 104 beats per minute (B.P.M.), a respiratory rate of 18 cycles per minute (C.P.M.), and oxygen saturation of 99% on room air. On musculoskeletal examination, there was no paraspinal or spinal swelling inspection, and no paraspinal or spinal tenderness on palpation. Respiratory and cardiovascular examinations were normal. His initial working diagnosis was hypertensive urgency, and he was initially treated with intravenous labetalol 20 mg pushes but was switched to a nicardipine drip at 5 mg/hr due to poor control.