Problem:
HPI: KC is a 46 yo male who awoke this morning with severe and intensifying pain in his left flank. He presents to the emergency department in severe acute distress with significant anxiety, pallor, and diaphoresis. He developed nausea from the pain and vomited twice. He has already received IV ondansetron for nausea and IV morphine for pain. PMH: He has a history of non-Hodgkin lymphoma at age 38, now in remission, and IgG immunodeficiency determined to be secondary to lymphoma or chemotherapy. PMH also includes history of Zenker's diverticulum and renal stones. Allergies: Demerol Exam: Skin is pale, cool, and clammy and there is evidence of healed surgical scars on his back from removal of several sebaceous cysts. He is unable to remain stationary on the stretcher; he is constantly repositioning himself. He frequently groans and verbalizes statements of pain. He ranks pain in left flank 8/10 and describes it as intermittent. His vital signs are: BP 142/86, HR 110, RR 18, oral temp 99.0 F. 1. What is your top differential diagnosis? Please support your answer.