Blood to the Bone: Epistaxis Leading to Osteomyelitis.

Apixaban is a direct Factor Xa inhibitor that has been increasingly prescribed, particularly for stroke prevention in atrial fibrillation. While safer than warfarin, it still carries bleeding risks, including epistaxis, which is commonly managed with nasal packing. We report a 75-year-old woman on apixaban who developed methicillin-resistant Staphylococcus aureus (MRSA) bacteremia after nasal packing for epistaxis. She presented a few weeks later with worsening back pain and was diagnosed with L2-L3 vertebral osteomyelitis from MRSA. The case highlights the rare risk of distant osteomyelitis following nasal packing and the importance of evaluating changes in chronic pain.