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A 60+ year\u2009old male patient with HHT type 1 (status post six pulmonary AVM coiled embolisations) with epistaxis presented with intractable back pain, methicillin-sensitive <jats:italic>Staphylococcus aureus<\/jats:italic> (MSSA) bacteraemia and spinal MRI revealing spondylodiskitis and L4-L5 epidural phlegmon. He has an extensive history of deep-seated infections including two prior spinal infections, two joint infections and one muscular abscess\u2014all with MSSA. The patient was treated with 6\u2009weeks of intravenous nafcillin with symptom resolution. Infectious disease prescribed cefalexin 500\u2009mg daily for suppression of infection recurrence considering his extensive deep-seated infection history and multiple risk factors. This case raises important questions about preventative antimicrobial management of high-risk patients with HHT, which is a grey area in current international HHT guidelines.<\/jats:p>","DOI":"10.1136\/bcr-2023-258558","type":"journal-article","created":{"date-parts":[[2024,10,7]],"date-time":"2024-10-07T23:00:12Z","timestamp":1728342012000},"page":"e258558","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Hereditary haemorrhagic telangiectasia type 1 complicated by recurrent deep-seated MSSA infections necessitating lifelong antibiotic suppression"],"prefix":"10.1136","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6689-0216","authenticated-orcid":false,"given":"Evan Paul","family":"Tracy","sequence":"first","affiliation":[{"name":"Medicine, University of Louisville, Louisville, Kentucky, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Iyanujesu","family":"Adereti","sequence":"additional","affiliation":[{"name":"Psychiatry, University of Louisville, Louisville, Kentucky, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justin","family":"Chu","sequence":"additional","affiliation":[{"name":"Sports Medicine, University of Louisville, Louisville, Kentucky, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julianna","family":"Brown","sequence":"additional","affiliation":[{"name":"Medicine, University of Louisville, Louisville, Kentucky, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,10,7]]},"reference":[{"key":"2025082707402878000_17.10.e258558.1","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1159\/000479632","article-title":"The lung in hereditary hemorrhagic telangiectasia","volume":"94","author":"Dupuis-Girod","year":"2017","journal-title":"Respir"},{"key":"2025082707402878000_17.10.e258558.2","unstructured":"McDonald J , Stevenson DA , et al . 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