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A 65-year-old man comes to your office for the evaluation of lower back pain. For the past 3 days, he has had a sharp, burning pain in his left lower back, which would radiate to his flank and, sometimes, all the way around to his abdomen. The pain comes and goes, feels like an "electric shock," is unrelated to activity, and can be severe. He has had no injury to his back and has no history of back problems in the past. He denies fever, urinary symptoms, or gastrointestinal symptoms. Upon examination you note he has a rash is in the area of the pain. On examination he has an eruption consisting of patches of erythema with clusters of vesicles extending in a dermatomal distribution from his left lower back to the midline of his abdomen.
1. What is the probable diagnosis?
2. What are other possible diagnoses?
3. At this stage of the case study, what diagnostic studies and basic treatments are most appropriate to order and why?
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