Vertebral osteomyelitis caused by Nocardia asteroides: report and review of the literature.

A 65-year-old man with 9 months of radicular lower back pain was admitted for treatment of presumed malignancy of the lumbar spine. Lumbar radiographs showed destruction of the L4-L5 endplates and obliteration of the disc space, which was more compatible with an infectious process. After 2 different closed biopsy specimens failed to reveal an etiologic organism, N. asteroides was cultured from an open biopsy sample of the affected vertebrae. This and 8 other cases in the English literature of vertebral osteomyelitis caused by N. asteroides are reviewed.