Painless vertebral osteomyelitis: an unusual presentation

Vertebral osteomyelitis or discitis is a condition characterised by inflammation to the vertebral disc space and is often related to infection. It usually involves the discovertebral junction, and may extend to the epidural space, posterior vertebral elements and paraspinal tissues. This is an unusual case of a 68-year-old gentleman who presented to hospital confused and unwell with a methicillin-resistant Staphylococcus aureus bacteraemia. Clinical examination and routine investigations revealed no obvious source of infection. Despite thorough examination of his spine, no back pain or focal neurology were elicited, but with no obvious source of infection MRI of the spine was carried out which revealed a vertebral osteomyelitis with paravertebral abscess formation.