Tao Li,1,2 Shaohua Liu1,2 

1Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Changsha, 410008, People’s Republic of China; 2National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, People’s Republic of China

Correspondence: Shaohua Liu, Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Changsha, 410008, People’s Republic of China, Email liushaohua@csu.edu.cn

Introduction: Tuberculosis is prevalent in high-burden countries. However, spinal multi-drug resistant tuberculosis (MDR-TB) in patients with normal immune function is a disease that is prone to misdiagnosis and even delayed diagnosis. Recently, we successfully treated one such patient.
Case Presentation: A 46-year-old male patients with lower back pain associated with recurrent fever 2 months before admission. The patient was misdiagnosed as a suppurative spinal infection and failed to respond to treatment for 2 months. The muscle strength of both lower limbs decreased progressively. We performed two operations to clear the lesion and decompress the spinal canal, during which we found a fish-like inflammatory tissue mimicking a suppurative infection. Finally, the patient was diagnosed with lumbar MDR-TB by culture, Xpert MTB/RIF and metagenomic next-generation sequencing (mNGS). The second-line anti-tuberculosis treatment (ATT) is cycloserine + para-aminosalicylic acid + ethambutol + levofloxacin + linezolid. Finally, the patient’s symptoms were relieved and the muscle strength of both lower limbs recovered.
Conclusion: This case prompt MDR-TB of the spine is not a typical clinical symptoms and imaging examination is the lack of specificity, when for the diagnosis of patients with spinal bone destruction unclear or treatment is invalid, can diagnostic anti-tuberculosis treatment. For patients with spinal instability or spinal canal occupying, early surgical removal of lesions, tissue culture, Xpert MTB/RIF and mNGS to identify pathogens and drug resistance, timely diagnosis and treatment can maximize the prognosis of spinal MDR-TB.

Keywords: multi-drug resistant tuberculosis (MDR-TB), antituberculosis treatment(ATT), metagenomic next-generation sequencing (mNGS), Xpert MTB/RIF