Session Information
Date: Saturday, November 16, 2019
Session Title: Spine and Pain Case Report
Session Time: 11:15am-12:45pm
Location: Research Hub - Kiosk 6
Disclosures: Jonathan Song, DO: Nothing to disclose
Case Description: The patient went to his chiropractor without improvement and then visited his PCP for evaluation. The back pain was progressing and he had low grade fever at the time of his PCP visit. He was prescribed physical therapy with OTC medications for pain relief at that time. Symptoms continued to worsen over the next 2 months to the point of not being able to tolerate therapy or work and decided to come to MSK/Sports Clinic for evaluation. During review of systems, patient endorsed an 18-pound unintentional weight loss as well consistent low grade fevers with a temperature max of 102 just a few days prior to his visit.
Setting: Outpatient Musculoskeletal Sports Medicine Clinic
Patient: A 57-year-old male with chronic low back pain for the past 30 years with a 3-month history of worsening low back pain.
Assessment/Results: Expedited labs revealed a normal WBC of 7.4, but an elevated ESR (35) and sed rate (36). An MRI lumbar spine revealed enhancing inflammatory changes within the vertebral bodies around the L4-L5 disk compatible with an infectious process of undetermined age. Patient was sent to ED and admitted. Patient underwent a CT-guided core biopsy of the L5 vertebral body with no growth while blood cultures were positive for Streptococcus mitis. Patient was treated with vancomycin, which was de-escalated to ceftriaxone, and recovered fully.
Discussion: Low back pain was reported by almost 66 million adults and is by far the most frequent musculoskeletal complaint in America. Though LBP is common, there are certain red flag symptoms that could represent serious life-threatening pathology.
Conclusion: In an age where cost saving and conservative treatments are exhausted before an insurance company can give permission to obtain advanced imaging, there are certain red flag symptoms that warrant emergent workup and further medical assessment of lower back pain.
Level of Evidence: Level V
To cite this abstract in AMA style:
Song J, Shami AE. Acute on Chronic Low Back Pain Initially Treated Conservatively Found to Be Diskitis and Osteomyelitis: A Cautionary Case Report [abstract]. PM R. 2019; 11(S2)(suppl 2). https://pmrjabstracts.org/abstract/acute-on-chronic-low-back-pain-initially-treated-conservatively-found-to-be-diskitis-and-osteomyelitis-a-cautionary-case-report/. Accessed May 15, 2025.« Back to AAPM&R Annual Assembly 2019
PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/acute-on-chronic-low-back-pain-initially-treated-conservatively-found-to-be-diskitis-and-osteomyelitis-a-cautionary-case-report/