Acute low back pain is one of the most common reasons for adults to see a physician. However, vertebral osteomyelitis (VO) is a rare condition, which mostly affects the lumbar spine. Lumbar spine MRI imaging is the diagnostic method of choice. If left untreated can lead to vertebral destruction or spinal abscess formation. Case: An 86-year-old man presented with a stroke to our facility, while undergoing therapy complained of excruciating low back pain that prevented him from undergoing therapy

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... specially standing and walking. His vital signs were normal, and he was afebrile. Plain X-ray of the lower spine showed osteoarthritic changes. Patient was initially started on non-steroidal anti-inflammatory (NSAID) with no change in the severity of his low back pain. Lumbar vertebral spine magnetic resonance imaging (MRI) showed lumbar vertebral osteomyelitis. Initiation of IV antibiotics dramatically decreased the pain severity. Conclusion: Low back pain is common in the elderly population and responds effectively to NSAID. Persistence of low back pain in the presence of pathognomonic changes in the lumbar spine MRI indicate the presence of VO. Prompt treatment with empirical antibiotics is warranted.