A 55-year-old man comes to the physician because of a 2-week history of back pain. He has not sustained any recent trauma. He has a history of end-stage renal disease receiving intermittent hemodialysis. He appears well. Temperature is 37.5°C (99.5°F), pulse is 79/min, and blood pressure is 124/78 mm Hg. The patient also has hypertension and type 2 diabetes mellitus and was treated several weeks ago for staphylococcal bacteremia associated with the dialysis catheter. Her temperature is 38 C (100.4 F). On examination, he has tenderness over the upper lumbar vertebrae without overlying skin changes. The straight leg raise test is negative. Which of the following is the best next step in management of this patient?

Question

A 55-year-old man comes to the physician because of a 2-week history of back pain. He has not sustained any recent trauma. He has a history of end-stage renal disease receiving intermittent hemodialysis. He appears well. Temperature is 37.5°C (99.5°F), pulse is 79/min, and blood pressure is 124/78 mm Hg. The patient also has hypertension and type 2 diabetes mellitus and was treated several weeks ago for staphylococcal bacteremia associated with the dialysis catheter.  Her temperature is 38 C (100.4 F).  On examination, he has tenderness over the upper lumbar vertebrae without overlying skin changes.  The straight leg raise test is negative.  Which of the following is the best next step in management of this patient?

Quizplus · Accepted Answer

Eductional Objective: Vertebral osteomyelitis should be suspected in patients with new or worsening back pain, fever, and recent endocarditis or bacteremia (especially Staphylococcus aureus).  It should also be suspected if there are new neurologic findings and fever with or without back pain.  MRI of the spine is preferred for diagnosis.

A 55-Year-Old Man Comes to the Physician Because of a 2-Week