Patient presents with complaints consistent with sacral osteomyelitis.  Symptoms include localized low back pain, sacral pain, tenderness to palpation over the sacrum, fever, chills, and possible purulent drainage.  Differential diagnosis includes psoas abscess, discitis, epidural abscess, pyelonephritis, and sacroiliitis.  Risk factors assessed include intravenous drug use, recent spinal surgery, diabetes mellitus, immunosuppression, and indwelling catheters.  Physical examination reveals localized erythema, edema, and warmth overlying the sacrum.  Neurological examination is within normal limits.  Laboratory findings demonstrate elevated white blood cell count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP).  Blood cultures obtained.  Imaging studies including MRI of the sacrum and pelvis ordered to confirm the diagnosis of sacral osteomyelitis and evaluate the extent of bone involvement.  Initial treatment includes intravenous broad-spectrum antibiotics targeting Staphylococcus aureus, the most common causative organism.  Surgical debridement may be necessary depending on the severity of infection and response to antibiotic therapy.  Patient education provided regarding medication administration, wound care if applicable, and follow-up appointments.  ICD-10 code M46.2  Sacral osteomyelitis, and appropriate CPT codes for evaluation and management, laboratory tests, and imaging studies will be documented.  Plan for infectious disease consultation and pain management as needed.  Prognosis depends on the severity of infection, underlying comorbidities, and patient's response to treatment.