A 55 year old man with type 2 diabetes mellitus and hypertension is admitted to hospital with several weeks of chronic back pain and subjective fever. He has no prostheses. He has no known drug allergies. He was born in Canada, has no known contacts with TB, and denies ingesting unpasteurized dairy products. He denies any changes in his bowel or bladder function nor any lower extremity weakness or sensory changes. He has not had any recent episodes of bacteremia and denies recent antimicrobial exposure.
On examination, he is afebrile and his vital signs are stable. No neurological deficits are present on examination. No stigmata of infective endocarditis are present. No rash is present on examination.
An MRI of his spine shows evidence of discitis and osteomyelitis involving his L1 and L2 vertebrae. No epidural abscess is seen. His CRP level is greater than 300 mg/L (normal range 0-7 mg/L). Two sets of blood cultures are negative for bacterial growth. His chest X-ray is normal.