A 43-year old male IV drug user presents to the ED with 2 weeks of fever, back pain, and progressive weakness in his arms bilaterally. He denies any history of recent trauma. His blood pressure is 130/75 mm Hg, heart rate is 106 beats per minute, temperature is 103°F, and respiratory rate is 16 breaths per minute. On physical exam, he has tenderness to palpation in the mid-thoracic spine, and decreased strength in the upper extremities bilaterally with normal range of motion. Laboratory results reveal a WBC 15,500/µL, hematocrit 40%, and platelets 225/µL. Which of the following is the most likely diagnosis?
a. Thoracic disk herniation
b. Ankylosing spondylitis
c. Spinal epidural abscess
d. Vertebral compression fracture
e. Spinal metastatic lesion
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