Diagnostic and Therapeutic Challenges in Native Vertebral Osteomyelitis: A Case Report of Infection Following Spinal Platelet-Rich Plasma Injection

Native vertebral osteomyelitis (NVO) is an infection of the vertebral bodies and intervertebral discs that can result in significant morbidity if diagnosis or treatment is delayed. A 35‑year‑old man with chronic low‑back pain underwent a lumbar platelet‑rich plasma (PRP) injection. Approximately four months after the procedure, he developed new-onset low‑back pain that progressively worsened over the course of four weeks, accompanied by intermittent fevers and bilateral leg weakness. Magnetic resonance imaging (MRI) revealed L4-L5 discitis with adjacent end‑plate involvement, consistent with NVO. Blood cultures were negative, and two computed tomography (CT) guided biopsies failed to yield sufficient material for pathogen identification. Empiric broad‑spectrum antimicrobial therapy was initiated. The patient's treatment course was complicated by drug‑induced transaminitis and vancomycin flushing syndrome, requiring several regimen modifications. He ultimately stabilized on intravenous daptomycin and levofloxacin and was discharged with plans for six weeks of outpatient therapy and close follow‑up. This case highlights PRP injection as a potential iatrogenic source of NVO. Clinicians should maintain a high index of suspicion for spinal infection in patients presenting with new or worsening back pain weeks to months after minimally invasive spinal procedures. Early imaging, multidisciplinary management, and patient counseling on post-procedure infection risks are critical, especially when culture data are unavailable and empiric therapy must be carefully adjusted over time.