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Spinal epidural abscess from Staphylococcus aureus bacteraemia — SCE Acute Medicine MCQ

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HardMusculoskeletal systemSpinal epidural abscess from Staphylococcus aureus bacteraemiaSCE Acute Medicine

A 57-year-old man with diabetes and recent Staphylococcus aureus bacteraemia presents with thoracic back pain and fever. CRP is 210 mg/L and he has new leg weakness with brisk reflexes. Blood cultures are positive again. What is the most appropriate next investigation?

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Correct answer: D — Urgent MRI spine to assess vertebral osteomyelitis and epidural abscess

Back pain, S. aureus bacteraemia and neurological signs suggest vertebral osteomyelitis with possible epidural abscess causing cord compression; urgent MRI is required. Waiting for culture sensitivities risks neurological deterioration. Lumbar puncture may be dangerous and does not assess epidural compression.

Reference: IDSA vertebral osteomyelitis guideline; NICE CKS back pain red flags