Pyogenic spondylitis typically presents with back and neck pain, fever, and fatigue. Sharp chest pain upon deep breathing, commonly associated with pleurisy, is not a typical manifestation of pyogenic spondylitis. We report a case of pleuritic chest pain as the initial presentation of pyogenic spondylitis. A 62-year-old male patient presented with a one-week history of right-sided pleuritic chest pain and fever. Chest computed tomography (CT) revealed a right pleural effusion. The patient was initially treated for bacterial pleurisy without improvement and subsequently developed back pain. Blood cultures yielded methicillin-resistant