A Case of Vertebral Osteomyelitis with an Erector Spinae Abscess Caused by Staphylococcus argenteus ST1223

Staphylococcus argenteus is a novel bacterial species distinct from Staphylococcus aureus. Nevertheless, S. argenteus is often misidentified as S. aureus because they cannot be differentiated easily using routine diagnostic microbiology methods. An 81-year-old man was admitted because of persistent lumbar pain and fever. Strains from his blood cultures were initially identified as methicillin-susceptible S. aureus. Enhanced computed tomography revealed an erector spinae abscess connected with the L5 transverse process, and magnetic resonance imaging of the lumbar region showed a high intensity of L1 and L5 on short tau inversion recovery. The abovementioned pathogen was also cultured from the aspiration fluid of the abscess. Therefore, the patient was diagnosed with vertebral osteomyelitis with an erector spinae abscess. We analyzed the detected strain using matrix-assisted laser desorption ionization time-of-flight mass spectrometry and whole-genome sequencing, re-identifying the strain as S. argenteus sequence type (ST) 1223. Although S. argenteus ST1223 has mainly enteric pathogenicity, our case suggests its potential to invade the musculoskeletal system. Its pathogenicity was similar to or greater than that of S. aureus in both previous studies and our case. Therefore, the clinical differentiation of S. argenteus and S. aureus warrants further investigation.