Why can't he walk?

45 year old man was brought to the clinic. Conscious, oriented to time and place. He was screaming of severe waist pain, back pain, hip pain, left flank pain, and sudden onset inability to walk. He had to be carried into bed. There was no history of trauma, no fall or no injury. He's a taxi driver by profession.

He has no known medical conditions. He has not had any surgical procedures done. Not on any medication. He has never experienced this episode of pain and inability to walk. His abdomen was full, non-tender, renal angle tenderness positive on left side. Failed pin prick test and patellar reflex (hyporeflexia).

Vitals

• Blood pressure: 150/108mmHg
• Pulse: 110bpm
• Spo2 - 98%
• Respiratory: 22 cpm
• Temp-36.5 degree Celsius

Administered on arrival: IVF Normal Saline 500mls stat, IV paracetamol 1 g stat, Inj Diclofenac 75 mg stat. Antibiotics started on suspicion of Acute Pyelonephritis to rule out Nephrolithiasis. While awaiting lab investigations: Urine R/E, FBC, Bf for malaria parasites. Renal function test, Ultrasound and X-ray unavailable. After 30 minutes he still complained of pain hence Inj Morphine 5 mg administered, this relieved his pain while closely monitoring BP.

Lab results

• FBC: (WBC-12.3, Granulocytes:80.1, Hb:12.1 PLT: 122)
• Urine R/E: (Amber, Hazy, Leucocytes seen, blood seen (hemolyzed), proteins seen, glucose seen, no Nitrite, no Crystals, epithelial cells 5/10, no bacteria). Due to Glucosuria RBS checked 13 mmol/l.

X-ray, CT-scans came back normal, Abd-pelvic USG: no obstruction, dilated loops of bowel noted.

Patient is no longer in pain, but still cannot walk. What could be the diagnosis?

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