Vertebral osteomyelitis usually presents with clinical manifestations, laboratory data and radiographic changes that are non-specific. This makes it difficult to diagnose during the early stages of the disease and consequently this increases morbidity. As a result it is a challenging diagnosis to most clinicians, especially the emergency physician. I report a case of vertebral osteomyelitis associated with paravertebral abscess diagnosed at an emergency department. This patient presented with back pain only and was discharged without complication after conservative treatment.