{"id":4688,"date":"2012-05-02T15:25:32","date_gmt":"2012-05-02T19:25:32","guid":{"rendered":"https:\/\/www.bumc.bu.edu\/im-residency\/?p=4688"},"modified":"2012-05-02T15:25:32","modified_gmt":"2012-05-02T19:25:32","slug":"when-is-a-backache-not-just-a-backache","status":"publish","type":"post","link":"https:\/\/www.bumc.bu.edu\/im-residency\/2012\/05\/02\/when-is-a-backache-not-just-a-backache\/","title":{"rendered":"When is a backache not just a backache?"},"content":{"rendered":"<p>We discussed a 32yom with past IVDU (none in 10 years) and type I diabetes who presented with lumbar back pain radiating down his left leg for 2 months and worse for the last few days, to the point where he couldn&#8217;t sit or lay down comfortably. He had a history of an untreated +PPD, IVDU last 10 years ago, cocaine use last 1 year ago and poorly controlled type I diabetes. His exam was notable for mild tachycardia and a systolic murmur at the L lower sternal border. He had point tenderness in the upper lumbar region and hyperesthesia in his left leg.<\/p>\n<p>Remember to follow guidelines for imaging in low back pain. 2011 ACP guidelines are reviewed in Table 4 of this <a href=\"http:\/\/www.annals.org\/content\/154\/3\/181.full.pdf\">article<\/a>. MRI of vertebral osteomyelitis is characteristically hypointense on T1 and hyperintense on T2 with involvement of the disk first and then the adjacent vertebral bodies. Imaging may lag infection by 2-4 weeks.<\/p>\n<p>Bacteriologic diagnosis in vertebral osteomyelitis is useful in tailoring antibiotics. 2 blood cultures prior to antibiotic initiation is the guideline. If those do not yield a result, the recommendation is to pursue tissue diagnosis with vertebral biopsy.<\/p>\n<p>This patient is diagnosed with MSSA vertebral osteomyelitis by blood culture alone. His type I diabetes and misuse of his insulin needles likely put him at risk. He also seeded his L hip and had complete destruction of the joint requiring joint resection.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>We discussed a 32yom with past IVDU (none in 10 years) and type I diabetes who presented with lumbar back pain radiating down his left leg for 2 months and worse for the last few days, to the point where he couldn&#8217;t sit or lay down comfortably. He had a history of an untreated +PPD, [&hellip;]<\/p>\n","protected":false},"author":5942,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[4854],"tags":[4866],"_links":{"self":[{"href":"https:\/\/www.bumc.bu.edu\/im-residency\/wp-json\/wp\/v2\/posts\/4688"}],"collection":[{"href":"https:\/\/www.bumc.bu.edu\/im-residency\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.bumc.bu.edu\/im-residency\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.bumc.bu.edu\/im-residency\/wp-json\/wp\/v2\/users\/5942"}],"replies":[{"embeddable":true,"href":"https:\/\/www.bumc.bu.edu\/im-residency\/wp-json\/wp\/v2\/comments?post=4688"}],"version-history":[{"count":0,"href":"https:\/\/www.bumc.bu.edu\/im-residency\/wp-json\/wp\/v2\/posts\/4688\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.bumc.bu.edu\/im-residency\/wp-json\/wp\/v2\/media?parent=4688"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.bumc.bu.edu\/im-residency\/wp-json\/wp\/v2\/categories?post=4688"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.bumc.bu.edu\/im-residency\/wp-json\/wp\/v2\/tags?post=4688"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}