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In the following days, the infection in the foot improved step by step, but the fever increased and the back pain worsened. Figure 1 Osteomyelitis of the head of fifth metatarsus in the left foot. Investigation Blood tests carried out at the time of admission revealed the following: white blood cells (WBC) 7.15��109/L (normal range (NR): 4.3�C10), hemoglobin 89g/L (NR: 135�C170), platelets 119��100000/mm3 (NR: 150�C450), fasting glucose 8.6mmol/L (NR: 3.5�C5.5), HbA1c 36mmol/mol, ALT 14U/L (NR: 6�C50), GGT 116 U/L (NR: 4�C60), creatinine 130��mol/L (NR: 53�C115), C-reactive protein Mianserin HCl (CRP) 159mg/L (normal value: SCR7 supplier two sets of blood cultures indicated Staphylococcus aureus infection. The antimicrobial sensitivites showed that the isolated microorganism was susceptible to all beta-lactam antibiotics, including piperacillin/tazobactam. To keep out other sites of infection, urinalysis and urine culture, as well as chest X-ray, ultrasound abdomen, and transthoracic echocardiogram (TTE) had been performed. All investigations were negative. However, as TTE could not assess very little vegetations (i.e. click here Moreover, an enhancement of the muscles ileum psoas bilaterally and the enhancement in the intracanal epidural tract from L4 to S1 were also recognized (Fig. 2, Panel A). These findings suggested a serious osteomyelitis in L4 and L5 complicated by an epidural abscess. Figure 2 (Panel A) Vertebral osteomyelitis in L4 (gray arrow) and L5 (white arrow) complicated by epidural abscess (small gray arrow) evaluated with MRI. (Panel B) Persistence of radiological signs (gray arrow in L4 and white arrow in L5) of vertebral osteomyelitis ... Treatment The clinical case was discussed with the neurosurgeon and the infectivologist: there were no indications for surgical intervention, and conservative treatment with high doses of piperacillin/tazobactam was continued at the Infectious Diseases Department. The intravenous antibiotic therapy lasted for 12 weeks.