A 14-Year-Old Girl With 2 Weeks of Severe Back Pain

Educational Objectives• • Empiric antimicrobial coverage for suspected osteomyelitis typically targets Staphylococcus aureus, the most common bacteria responsible for osteomyelitis in immunocompetent children older than 3 months.In patients with lack of response to empiric antibiotics within the first few days, it is important to consider atypical causes of osteomyelitis such as Brucella in those with unpasteurized dairy exposure, Mycobacterium tuberculosis in those from endemic areas, Salmonella in those with sickle cell disease or immunocompromised status, or Candida or Aspergillus in immunocompromised patients or IV drug users.• • In patients with extraintestinal manifestations of non-typhoidal Salmonella infection, such as osteomyelitis, evaluation for immunodeficiency should be considered.