Hematogenous pyogenic vertebral osteomyelitis (VO) is a rare and often fatal complication of osteomyelitis that can affect individuals with underlying medical conditions, hospital-acquired infections, and intravenous (IV) drug abuse. Pyogenic vertebral osteomyelitis can present with generalized back pain, pyrexia, motor weakness, and neurologic deficits. The enigmatic presentation of this condition often results in delays in diagnosis and an increase in mortality. This case report aims to bring awareness to complications of hematogenous pyogenic vertebral osteomyelitis as well as highlight the need for further studies in order to establish standardized treatment. In our report, we depict a case of complicated pyogenic VO that required pharmacological and surgical intervention.

Basal cell carcinoma (BCC) is the most common cancer worldwide, with an increasing annual incidence 1,2 -In patients with advanced BCC, lesions become extensively locally invasive or metastatic, and traditional first-line surgical treatment may be contraindicated 3 • Hedgehog pathway inhibitors (HHIs) represent an alternate treatment option for patients with advanced BCC 4 -HHIs block the aberrant Hedgehog pathway activation that allows transcription of glioma-associated oncogene transcription factors and activation of target genes for tumorigenesis and angiogenesis during development of BCC (Figure 1) 5 -Most HHIs prevent Hedgehog signaling by binding to and preventing activation of transmembrane protein Smoothened 5

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