Clinical Report: A Spinal TB Mimic: Salmonella Dublin

Overview

This case report details the identification of Salmonella Dublin as the causative pathogen in a 14-year-old boy initially suspected of having spinal tuberculosis. The patient underwent surgical debridement and subsequent targeted antimicrobial therapy, resulting in significant clinical improvement.

Background

Spinal tuberculosis is a common concern in regions with high TB prevalence, often leading to misdiagnosis due to overlapping clinical features with other infections. Invasive nontyphoidal Salmonella, while rare, can present similarly and may lead to severe complications if not identified promptly. This case underscores the importance of accurate diagnosis in atypical presentations of spinal infections.

Data Highlights

No numerical data or trial data available in the source material.

Key Findings

• Initial symptoms included fever, cough, lumbar pain, and weight loss.
• Imaging revealed vertebral destruction and a psoas muscle abscess, raising suspicion for spinal tuberculosis.
• Empirical anti-tuberculosis therapy was ineffective, prompting further investigation.
• Surgical debridement and tissue culture identified Salmonella Dublin as the pathogen.
• Targeted therapy with imipenem/cilastatin led to rapid clinical improvement.
• Metagenomic next-generation sequencing (mNGS) proved crucial in pathogen identification.

Clinical Implications

Clinicians should consider invasive nontyphoidal Salmonella in the differential diagnosis of spinal infections, especially in TB-endemic areas. Early surgical intervention and targeted antimicrobial therapy can significantly improve outcomes in cases where initial treatments fail.

Conclusion

This case highlights the diagnostic challenges posed by atypical presentations of spinal infections and the critical role of surgical intervention and advanced diagnostic techniques in achieving accurate diagnosis and effective treatment.

References

1. Guo S., Zhu Y., Frontiers in Medicine, 2023 -- A Spinal TB Mimic: Salmonella Dublin
2. Infection — Case Report of Concurrent Multi-Site Spinal Tuberculosis and Urogenital Tuberculosis Detected via 18 F-FDG-PET/CT in the Spinal TB X Cohort
3. The Journal of Infectious Diseases — A Glycolipid-Based Vaccine Induces Cross-Reacting Antibodies Targeting Salmonella Species and Provides Protection Against Invasive Nontyphoidal Salmonella Infections in Murine Models
4. Infection — Fatal Disseminated Reactivation of Bovine Tuberculosis in a Patient Undergoing Adalimumab Therapy: A Case Study and Literature Review
5. Infection — A Unique Clinical Presentation: Concurrent Infections Leading to Guillain-Barré Syndrome, Recurrent Fever, and Mesenteric Lymphadenopathy
6. IDSA 2015 Clinical Practice Guidelines for the Diagnosis and Treatment of Native Vertebral Osteomyelitis in Adults
7. Epidemiology of Salmonella enterica Serotype Dublin Infections among Humans, United States, 1968–2013