Pleuritic Chest Pain as an Initial Presentation of Pyogenic Spondylitis

Pyogenic spondylitis typically presents with back and neck pain, fever, and fatigue. Sharp chest pain upon deep breathing, commonly associated with pleurisy, is not a typical manifestation of pyogenic spondylitis. We report a case of pleuritic chest pain as the initial presentation of pyogenic spondylitis. A 62-year-old male patient presented with a one-week history of right-sided pleuritic chest pain and fever. Chest computed tomography (CT) revealed a right pleural effusion. The patient was initially treated for bacterial pleurisy without improvement and subsequently developed back pain. Blood cultures yielded methicillin-resistant Staphylococcus aureus (S. aureus​​​​). Additional thoracic spine magnetic resonance imaging (MRI) demonstrated pyogenic spondylitis with abscess formation on the right side of the vertebral body. The final diagnosis was pyogenic spondylitis that had progressed and spread inflammation to the pleura. This case highlights that pyogenic spondylitis can cause secondary pleurisy due to extension of inflammation to adjacent structures, a possibility that should be recognized. When S. aureus bacteremia is detected during the course of pleurisy, clinicians should consider secondary pleurisy and perform imaging studies to evaluate for pyogenic spondylitis.