1. I-Ta Tsai Intern, National Yang-Ming University Case Presentation

2. General Data 49-year-old male 板模工人

3. Chief Complaint Progressive upper back pain for 3 days

4. Right shoulder & knee pain and swelling 2007.04 2007.03 2007.04 2007.07 2007.06 Synovial fluid Cold sweating Weight ↓ 12 kg Oral ulcer Septic arthritis RA ? Prednisolone Celecoxib Plaquenil Methotrexate Salazopyrin

5. Bacteremia (OSSA) 2007.03 2007.04 2007.07 2007.06 Echocardiography: (-) Abdominal CT: abscesses Lower limbs weakness Spine MRI Drainage Moxifloxacin Epidural abscesses T5-T8, L1-L3, & L3-S1 Laminectomies Culture: K. pneumoniae, ESBL Ertapenem

6. 2007.03 2007.04 2007.07 2007.06

7. Fever & dyspnea 2007.03 2007.04 2007.07 2007.06 BCx: GPC Oxacillin Skin eruption Vancomycin OSSA Drug allergy ? TEE: (-)

8. 2007.03 2007.04 2007.07 Upper back pain Numbness, tingling pain to ant. chest Tenderness at T spine area Osteomyelitis Residual epidural abscess

9. Personal History Heavy smoker Alcoholism No HTN/DM/hepatitis Herbs: black pills

10. Past History Hemorrhoid COPD Operation: Laminectomy

11. Allergy History Oxaillin, urticaria-like No food/transfusion allergy

12. Family History No IMRH family history

13. Review of System No fever/chills, skin rash No nuchal stiffness/pain No cough No heel pain Numbness, no weakness

14. Review of System No Raynaud's phenomenon No erythema nodosum No petechia/purpura No incontinence

15. Physical Examination Normal skin turgor, no rash No oral ulcer No neck stiffness Clear breath sounds Abd: soft, no tenderness

16. Physical Examination Vertebral knocking pain No petechia No Osler's node No rheumatoid nodule Abnormal spine movement

17. Impression Chronic osteomyelitis Residual prevertebral abscess

18. Hospitalization BCx: OSSA Osteomyelitis scan: (-) MRI: T 7-8 spondylodiscitis with disc buldging NS: no surgery CM: suggest HBO

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