Culture and metagenomic next-generation sequencing (mNGS) of surgically excised tissue established Salmonella Dublin as the causative pathogen in a 14-year-old boy initially suspected of having spinal tuberculosis, according to a case report published in Frontiers in Medicine.
The patient, living in a region with a high prevalence of tuberculosis, was evaluated for fever, cough, lumbar pain, and unintentional weight loss. He was admitted following 16 days of back pain and 10 days of fever, with a documented weight loss of 4.5 kg. Physical examination showed thoracolumbar spine tenderness. Laboratory testing showed elevated inflammatory markers, including C-reactive protein and erythrocyte sedimentation rate, with a normal white blood cell count.
Initial microbiologic evaluation, including blood and urine cultures, tuberculosis screening tests, and blood mNGS, was negative. Computed tomography and magnetic resonance imaging (MRI) showed pulmonary nodules, narrowing of the intervertebral space at T12–L1, vertebral bone destruction, paraspinal soft tissue swelling, and a psoas muscle abscess. Given the combination of systemic symptoms, imaging findings, and epidemiologic context, spinal tuberculosis was strongly suspected.
Empirical broad-spectrum antibiotic therapy was initiated without clinical improvement, followed by diagnostic anti-tuberculosis treatment with isoniazid, rifampin, pyrazinamide, and ethambutol. Despite this approach, follow-up MRI showed progression of vertebral lesions. “The diagnostic and therapeutic course in this case was particularly challenging. Initially, clinical evidence strongly suggested a tuberculosis infection,” noted lead study author Shuai Guo and coauthor Yu Zhu, of the Department of Pediatrics at West China Second University Hospital of Sichuan University, Chengdu, China.
Given ongoing disease progression, the patient underwent surgical debridement to obtain tissue for definitive diagnosis. Culture and mNGS of the excised lesion identified Salmonella Dublin, establishing the diagnosis of invasive non-typhoidal Salmonella spondylitis. Following multidisciplinary discussion involving pediatric infectious diseases, orthopedics, radiology, and pharmacy teams, anti-tuberculosis therapy was discontinued, and treatment with imipenem/cilastatin was continued based on antimicrobial susceptibility testing.
The presence of fever, weight loss, pulmonary nodules, and destructive vertebral lesions in a tuberculosis-endemic setting supported a presumptive diagnosis of tuberculosis. Surgical tissue sampling identified the causative pathogen, leading to discontinuation of ineffective anti-tuberculosis therapy and initiation of targeted antimicrobial treatment.
The patient responded promptly to targeted therapy, with resolution of fever and subsequent radiographic improvement in vertebral and paraspinal findings. He completed a prolonged course of intravenous and oral antimicrobial treatment and recovered without reported complications, ultimately resuming normal activities.
The researchers reported that publication funding was provided by the National Science and Technology Major Project of China (No. 2025ZD01907802). They declared no commercial or financial relationships relevant to the work.
Source: Frontiers in Medicine
