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COPD exacerbation — ABIM Board MCQ

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HardPulmonary/Critical CareCOPD exacerbationABIM Board

A 66-year-old man has persistent methicillin-susceptible Staphylococcus aureus bacteremia and focal thoracic back pain. MRI shows T8–T9 discitis-osteomyelitis with a small paravertebral phlegmon but no epidural compression. He is hemodynamically stable and has no neurologic deficit. What diagnostic step is most appropriate?

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Correct answer: A — Treat the established pathogen without routine image-guided vertebral biopsy

The best answer is “Treat the established pathogen without routine image-guided vertebral biopsy”. In compatible native vertebral osteomyelitis, sustained S. aureus bloodstream infection establishes a microbiologic diagnosis and ordinarily obviates image-guided biopsy. Directed antimicrobial therapy, endocarditis evaluation, serial clinical and inflammatory-marker assessment, and surgical review when instability, neurologic compromise, or uncontrolled infection develops are appropriate. Biopsy is most useful when blood cultures have not identified a typical pathogen, and withholding effective treatment here creates avoidable risk.

Reference: IDSA Guideline: Native Vertebral Osteomyelitis: https://www.idsociety.org/practice-guideline/vertebral-osteomyelitis/