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Background
Staphylococcus aureus has a predilection for musculoskeletal infection and has the capacity to rapidly spread throughout the body. This case highlights the complexity and severity of a metastatic S. aureus infection and the diagnostic and multispecialty approach required for full treatment.
Case presentation
The patient is a 43-year-old man who presented to the emergency room complaining of a 2-week history of progressive low back pain, which had become acutely worse over the past 4-5 days. The pain was severe (10/10) and exacerbated by any movement such as bending. He was seen by a midlevel provider who ordered labs showing a white cell count of 16×109/L as well as X-rays and a CT scan of his lumbar spine which were negative for pathology. He was discharged with pain medicine.
In 2days, he returned complaining of worsening back pain, this time with left leg pain radiating from his back to left lower extremity, inability to bear weight on his right lower extremity and numbness in his bilateral lower extremities. He also voiced general difficulty with ambulation. During a more detailed history and physical examination performed by the emergency physician, the patient denied any bowel or bladder symptoms, but did endorse recent fevers, chills and general malaise. He had a medical history of hypertension and type-2 insulin-dependent diabetes mellitus, for which he had recently stopped taking insulin. He also had a history of non-ischaemic cardiomyopathy requiring placement of an implantable cardioverter defibrillator and a remote episode of bacterial meningitis. Of note, the patient did have a history of abscesses in his axilla requiring debridement in his childhood. He denied any previous spine surgery, but did have an unspecified prior left knee surgery. He used marijuana daily, but denied use of intravenous drugs or tobacco.
During this encounter, he was admitted to the general medical service with a working diagnosis of infection of unknown source and was placed on empiric vancomycin, with little improvement. Two days after admission, he eventually underwent MRI examination of his spine, which was abnormal and the spine surgery service was consulted.
On examination by the spine surgery service, the patient was diaphoretic with gross swelling and warmth noted in his right knee and ankle. The patient was very irritable to any...