Thank you Dr. Walter Igawa-Silva for a great atypical presentation of Vertebral Osteomyelitis!

Teaching Points:

• Clinicians should suspect the diagnosis of native vertebral osteomyelitis in patients with new or worsening back or neck pain and fever  AND in patients with new or worsening back pain or neck pain and elevated ESR/CRP (IDSA; strong recommendation, low-quality evidence).
  • Clinical Features: Back pain (most common); Fever may not always be present
  • ESR/CRP have high sensitivity
• Pathophysiology: Hematogenous seeding> Direct innoculation or contiguous spread
• Obtaining blood cultures is crucial!
  • Positive culture may preclude more invasive procedures (ie bone biopsy)
  • S. aureus = most common pathogen
• MRI has high accuracy (90%) and assesses for abscess while ruling out herniated disk

IDSA Clinical Diagnostic Recommendations for Vertebral Osteomyelitis

Orchid announcement: Please order AFB rule-outs using the “MED Tuberculosis TB AFB Sputum bundle” shown below.