Working Diagnosis:
Discitis/Osteomyelitis of L4/L5 with Actinomyces Neuii

Treatment:
He was initially on Vancomycin and Zosyn, then deescalated to Ceftriaxone for eight weeks. Patient has currently transitioned to PO course of amoxicillin for 3 months.

Outcome:
One year later, he suffers with residual pain and is followed by pain management. His ADLS have not fully recovered.

Author's Comments:
This case illustrates the necessity to include vertebral osteomyelitis on initial differential diagnoses in patients with subacute back pain, even in absence of symptoms or risk for concomitant infection. Vertebral osteomyelitis is rare condition that often presents without warning signs of fever, neurological impairment, detailed source of infection, or leukocytosis. Delay in diagnosis caused by the non-specific nature of symptoms, results in increased mortality, recurrent infection, and neurological deficits. Heightening awareness of vertebral osteomyelitis in the sports medicine community can improve clinical outcomes.

References:
1. Mylona E, Samarkos M, Kakalou E, Fanourgiakis P, Skoutelis A. Pyogenic vertebral osteomyelitis: a systematic review of clinical characteristics. Seminars in arthritis and rheumatism. 2009;39(1):10-7. Epub 2008/06/14. doi: 10.1016/j.semarthrit.2008.03.002. PubMed PMID: 18550153.

2. McHenry MC, Easley KA, Locker GA. Vertebral osteomyelitis: long-term outcome for 253 patients from 7 Cleveland-area hospitals. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2002;34(10):1342-50. Epub 2002/05/01. doi: 10.1086/340102. PubMed PMID: 11981730.

3. Kehrer M, Pedersen C, Jensen TG, Lassen AT. Increasing incidence of pyogenic spondylodiscitis: a 14-year population-based study. The Journal of infection. 2014;68(4):313-20. Epub 2013/12/04. doi: 10.1016/j.jinf.2013.11.011. PubMed PMID: 24296494.

4. Beronius M, Bergman B, Andersson R. Vertebral osteomyelitis in Goteborg, Sweden: a retrospective study of patients during 1990-95. Scandinavian journal of infectious diseases. 2001;33(7):527-32. Epub 2001/08/23. PubMed PMID: 11515764.

5. Priest DH, Peacock JE, Jr. Hematogenous vertebral osteomyelitis due to Staphylococcus aureus in the adult: clinical features and therapeutic outcomes. Southern medical journal. 2005;98(9):854-62. Epub 2005/10/13. doi: 10.1097/01.smj.0000168666.98129.33. PubMed PMID: 16217976.

6. Torda AJ, Gottlieb T, Bradbury R. Pyogenic vertebral osteomyelitis: analysis of 20 cases and review. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 1995;20(2):320-8. Epub 1995/02/01. PubMed PMID: 7742437.

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