A 28 year old former college athlete was admitted to the hospital with severe back pain.

Without apparent reason this previously healthy individual experienced the onset of lower back pain approximately three weeks prior to admission. He continued to work as a utility lineman for a couple of days after the onset of his pain but had to cease working as the pain became excruciating. Pain medicine as provided at the time of an urgent care visit proved insufficient. Chiropractic manipulation likewise did not provide significant relief.

Ultimately, he saw his primary care physician, and an MRI scan was ordered revealing evidence of discitis and vertebral osteomyelitis at L4-L5 (see top image at left). He underwent percutaneous aspiration of the L4-L5 disc. The radiologist who performed this procedure described aspiration of 10-15 cc of bloody-purulent fluid. A photomicrograph of a gram stain of microbial growth cultured by means of this procedure is shown at lower left.

During the course of the patient’s illness he may have had low grade fevers and mild night sweats. He did experience episodes of chills. He denied history of injectable drug use or the ingestion of unpasteurized dairy products. He had not engaged in recent international travel. His wife had had several episodes of carbuncular MRSA skin disease in the months prior to the onset of the patient’s illness.

At the time of the patient’s admission labs included WBC 10.5, Hgb 15.3 ESR 67 (H); LFT's were within normal limits. Two blood cultures were negative. He was begun on IV vancomycin and ceftazidime after his percutaneous biopsy.