We were asked to see this 35 y/o man with back pain, paraparesis and fever. He is not a very healthy 35 y/o: long-term DM, obesity (weight fluctuates 315-350 lbs.), B/L ankle OA and a previous R great toe amputation because of PVD... He came to the hospital with high fevers (104) and back pain with B/L lower ext paresis. His MRI of the spine showed a lumbar disk herniation and a thoracic paraspinal inflammatory process (see below). Blood Cxs are + for Staph aureus. What would you do next and how would you manage him?
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Well, it's not osteo, but given the staph, I would at least check an echo for a source.
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