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A 55 year-old woman with history of rheumatoid arthritis with long-term steroid use (prednisone 15 mg per day) presented with a four to six week history of intermittent fevers, chills, occasional night sweats, and weight loss. CBC demonstrated pancytopenia. Initial work-up with cultures and imaging studies was non-diagnostic. Bone scan and MRI demonstrated lumbar vertebral body osteomyelitis. Diagnosis was ultimately made by lumbar vertebral biopsy, and bone marrow aspirate and biopsy.
Submitted by Robert Kazragis, MD, COL, MC, Infectious Disease Service, Dwight David Eisenhower Army Medical Center, Fort Gordon, GA. (Photomicrograph courtesy of LTC Randy Hamill, Department of Pathology, DDEAMC.)
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