ABSTRACT
A 34-year-old woman walked into emergency department at 8 PM complaining of severe back pain. She had experienced progressive lower back pain over the preceding 3 months, which she felt was associated with her increased exercise schedule, as she was currently training to run a marathon. On direct questioning, she described urinary frequency and nocturnal urinary incontinence and also mentioned that she had intermittent ‘pins and needles’ sensations in her right foot. She had been seen several times in the urinary incontinence clinic where investigations had not identified a cause for her symptoms and the impression was that the patient may have psychogenic polydipsia. Her past history included recurrent urinary tract infections, including an episode of pyelonephritis 2 years earlier, which had presented with back pain. She took no regular medications, did not drink alcohol or smoke, and was in a long-term monogamous relationship with a male partner. She worked as an apprentice at an investment banking company and had only travelled to New York and Hawaii in the preceding year.
