A 40 year old male contractor from Ecuador with history of untreated lower back trauma after falling off a ladder 5 years ago presents to the ED with acute lower back pain secondary to recent strain while lifting a heavy object. Patient denied IVDA, alcohol use, diabetes, recent infections, saddle anesthesia, or incontinence. He endorsed electric shock sensations down his right leg. Presenting vital signs were stable. Initial physical exam and CT were unremarkable. Later neurologic exam was remarkable for right patellar and ankle hyporeflexia, 4/5 strength in all leg movements at the right hip and below, and decreased sensation to fine touch in right leg except for medial thigh. Exam suggested radiculopathy in lumbosacral roots L3-L5.  MRI with contrast demonstrated 2.5cm ring-enhancing collection at L3-L5 level. Neurosurgical removal showed fibrous tissue with associated abscess. Pathology indicated reactive bone formation with inflammatory fibrous tissue alongside a necrotizing granuloma. Abscess cultures grew Staphylococcus aureus. Patient was started on cephalosporin antibiotics. Reactive bone formation suggests healing bone, possibly in the setting of a fracture. TEE was negative for endocarditis.

Outcome: Full resolution of symptoms with baseline ambulation.