<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 42-year-old man presents to the emergency department with a 3-day history of fever and severe back pain. The fever is high-grade, continuous, without chills and rigors. The back pain is severe, localized to the thoracic region, and aggravated by deep breathing. The patient tried taking ibuprofen with little improvement. Past medical history is significant for essential hypertension, dyslipidemia, hyperuricemia, and bronchial asthma. Current medicines include allopurinol, amlodipine, atorvastatin, clopidogrel, montelukast, and a corticosteroid inhaler. The patient reports a 25-pack-year smoking history and drinks alcohol only socially. His vital signs include: blood pressure 15294 mm Hg, pulse 101min, temperature 39.5C 103.1F. BMI 36.8 kgm2. On physical examination, the patient is alert and oriented. Multiple injection marks are visible around the left-sided cubital fossa and hand veins. The neck is supple on head flexion. Point tenderness is present in the thoracic region at the midline. Motor and sensory examinations are unremarkable with normal deep tendon reflexes. Laboratory findings are significant for the following:Hemoglobin 14.5 mgdLWhite blood cell 24,500mm3Platelets 480,000mm3BUN 28 mgdLCreatinine 1.1 mgdLESR 45 mmhrC-reactive protein 84 mgdLSodium 144 mEqLPotassium 4.1 mEqLCalcium 9.7 mEqLA contrast MRI of the spine reveals a peripherally enhancing dorsal epidural process compressing the thecal sac and causing a mild leftwards displacement. Which of the following is the most likely risk factor for this patients condition?? A: Alcohol use, B: Increased BMI, C: Inhaled steroid use, D: Intravenous drug use, E: Smoking,  <response>: Based on the description of high fever, severe localized back pain, elevated inflammatory markers like ESR and CRP, and MRI findings of epidural process compressing the thecal sac, this patient most likely has an epidural abscess. The risk factors for epidural abscess include IV drug use, diabetes, immunosuppression, and spinal procedures. The patient has a history of IV drug use evidenced by injection marks on his arms. IV drug use is a major risk factor for introducing infection into the epidural space. The other choices like alcohol use, obesity, inhaled steroid use, and smoking are not known risk factors for epidural abscess.D: Intravenous drug use 