A 70-year-old man, recently returned from Turkey, presented with fever, lower back pain and leg weakness. He volunteered that the hot, dry and dusty climate had led him to pick his nose, causing excoriation of the nasal mucous membranes. Although the results of biochemical and radiological investigation were suspicious for a malignant paraspinal soft tissue lesion, its resolution with antimicrobial chemotherapy pointed towards an infective aetiology. Staphylococcus aureus was cultured from blood. Subsequent investigation led to diagnoses of both diabetes mellitus and multiple myeloma, which predispose to infection. It is likely that damage to the nasal mucosal barrier caused transient staphylococcal bacteraemia and subsequent soft tissue seeding. This case demonstrates the importance of having a low threshold for early empirical antimicrobial therapy in patients presenting with fever and neurological abnormality, particularly when immunocompromised. It is also a reminder to correlate both radiological and clinical findings when making a diagnosis.
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Competing interests: None.
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