•57 year-old female presented acute onset left lower back and hip pain with difficult ambulating due to pain. Her initial CT Abdomen and Pelvis and MRI Lumbar Spine were only significant for omental infarct and degenerative joint changes.

•During her hospital course, she developed fever and leukocytosis. Repeat CTAP and MRI L-spine imaging were newly significant for  L4-5 discitis and osteomyelitis with extensive circumferential phlegmon.

•The patient was started on antibiotics based on culture sensitivity with laboratory and radiographic evidence of resolution of infection, but continued to endorse left left back and hip pain

•Pain medicine was consulted due to intractable pain despite oral and IV agents and initiation of antibiotics

•Interestingly throughout her entire hospital course, she had 4/5 positive physical exam maneuvers consistent with Sacroiliac Joint (SIJ) dysfunction including positive FABER, Compression, Distraction, and Gaenslens tests.