A previously healthy 13-year-old girl was admitted to the hospital due to 5 weeks of worsening lower back pain. Her pain was exacerbated by any movement such as walking or bending over, and the pain had been waking her up during the night in the days leading up to admission. Her pain was initially attributed to muscle strain, as a result of which she was seen by a physical therapist. She had also been taking ibuprofen with minimal relief. There was no obvious trauma noted although the patient recalled a minor abrasion to her back which happened during soccer practice. She reported no fever, cough, night sweats, joint pain, skin rash, or weight loss. Her immunizations were up to date, and she had not recently travelled nor had any contact with cats. In the emergency room, the patient was afebrile and her vital signs were stable. Her physical examination was unremarkable with the exception of mild lower back tenderness. Her laboratories revealed normal white blood cell counts (WBCs) of 9.2 x 103/mm3 with 58% neutrophils. She had elevated inflammatory markers; C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were 1 mg/dL (normal is less than 0.3) and 52 mm/h (normal is less than 15), respectively. A plain radiograph of her back (Figure 1) showed bony irregularity at the inferior aspect of T11 and superior aspect of T12. A magnetic resonance imaging (MRI) of her spine was consistent with vertebral osteomyelitis and discitis of T11 and T12 (Figure 2). A blood culture was obtained and she was started on intravenous (IV) vancomycin and ceftriaxone empirically. The antibiotic regimen was changed in 2 days to IV ceftaroline fosamil 400 mg q 8 h. The possibility of tuberculosis was ruled out by a negative interferon-gamma release assay. The orthopaedic surgeon was consulted and did not recommend surgical intervention. The patient's back pain improved, her blood culture showed no bacterial growth, and she was discharged home after 3 days of hospital stay. She had a central venous catheter placed, and she completed a total of 2 weeks of IV antibiotics and 6 weeks of oral antibiotics, sulfamethoxazole/trimethoprim and cefdinir, to empirically cover for S. aureus and Streptococcus species, respectively. She followed up with the infectious disease clinic which monitored her condition closely and followed her CRP, which normalized in 3 weeks. The patient had a full recovery, and she returned to her normal daily activities.