Mycobacterium xenopi is a rare cause of spinal osteomyelitis and discitis. Here we report the case of a 68-year-old woman with history of splenectomy for Felty's syndrome who developed M. xenopi lumbar discitis and osteomyelitis following repeated corticosteroid spinal injections for chronic back pain. Review of the 18 cases of M. xenopi spinal osteomyelitis cases described in the literature revealed common threads of immunocompromised hosts and prior spinal manipulation.