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SUMMARYWe report a case of spontaneous osteomyelitis of the cervical spine complicated by epidural abscess due to methicillin-resistant Staphylococcus aureus (MRSA) in a patient with rheumatoid arthritis with no obvious focus of infection or bacteraemia. The patient was on immunosuppressants and complete blood count revealed neutropaenia. He was successfully treated with intravenous antibiotics and surgery. BACKGROUND

The coronavirus disease 2019 (COVID-19) global pandemic has resulted in diversion of healthcare resources to the management of patients infected with SARS-CoV-2 virus. Elective interventions and surgical procedures in most countries have been postponed and operating room resources have been diverted to manage the pandemic. The Venous and Lymphatic Triage and Acuity Scale was developed to provide an international standard to rationalise and harmonise the management of patients with venous and lymphatic disorders or vascular anomalies. Triage urgency was determined based on clinical assessment of urgency with which a patient would require medical treatment or surgical intervention. Clinical conditions were classified into six categories of: (1) venous thromboembolism (VTE), (2) chronic venous disease, (3) vascular anomalies, (4) venous trauma, (5) venous compression and (6) lymphatic disease. Triage urgency was categorised into four groups and individual conditions were allocated to each class of triage. These included (1) medical emergencies (requiring immediate attendance), example massive pulmonary embolism; (2) urgent (to be seen as soon as possible), example deep vein thrombosis; (3) semi-urgent (to be attended to within 30–90 days), example highly symptomatic chronic venous disease, and (4) discretionary/non-urgent- (to be seen within 6–12 months), example chronic lymphoedema. Venous and Lymphatic Triage and Acuity Scale aims to standardise the triage of patients with venous and lymphatic disease or vascular anomalies by providing an international consensus-based classification of clinical categories and triage urgency. The scale may be used during pandemics such as the current COVID-19 crisis but may also be used as a general framework to classify urgency of the listed conditions.

What does the term "chronic venous disease" cover? The term "chronic venous disease" (CVD) covers a full spectrum of venous conditions of lower limbs, ranging from patients with early symptoms, like telangiectasia (reticular veins), leg pain, or oedema of the foot, to complications like venous leg ulcers. In the early stages usually only symptoms appear, then as the disease progresses it is accompanied by signs. Venous symptoms are defined as tingling, aching, burning sensation, muscle cramps, swelling, sensations of throbbing or heaviness, itching skin, restless legs, leg tiredness, or fatigue. These may be exacerbated during the course of the day by prolonged standing or by heat, and relieved with leg rest, elevation, or both. Venous signs are visible manifestations of chronic venous disease, which include [1]: • Oedema of the dorsum of foot, the entire foot, possibly extending to the leg; • Frank varicose veins: this may or may not be associated with telangiectasia or reticular veins; • Skin changes: dryness, frank eczema, darkened, thickened, hard, scarred, and ulcers.