A Case of Salmonella Enteritis Infection in the Lumbar Spine.

Background: In March 2024, our hospital confirmed a case of salmonella enteritis infection in the lumbar spine. The patient was admitted due to "back pain for 2 years and worsened for 3 months". Two years ago, the patient underwent lumbar spine fusion surgery at a local hospital due to lumbar spine disc herniation. Afterwards, the patient experienced repeated swelling and pain in the lower back. After rehabilitation therapy, the symptoms of back pain did not show significant relief. Three months ago, the patient's symptoms of lower back pain significantly worsened. Due to "lower back pain and lower limb pain", the patient was hospitalized in a local hospital for treatment. During hospitalization, fever, wheezing, and difficulty breathing occurred. The diagnosis was considered lumbar spine infection, and the patient was immediately transferred to the ICU for treatment, including tracheal intubation, invasive ventilator assisted ventilation. After treatment, the patient's breathing difficulties improved compared to before, but there was no significant relief in the symptoms of lower back pain. The patient sought further diagnosis and treatment at our hospital. The patient has had a history of tuberculosis for more than 10 years and has recovered; a history of emphysema for more than 10 years; history of lumbar spine fusion surgery for 2 years, with no history of other diseases.

Methods: Magnetic resonance imaging (spinal), CT (spinal), posterior lumbar spine 2 - 3 lesion clearance surgery under general anesthesia, pathological biopsy, bacterial culture, bacterial smear of excited lumbar spine tissue, NGS of lumbar spine tissue, and other auxiliary examinations: urine routine, blood routine, liver function, renal function, coagulation function, blood lipids, electrocardiogram.

Results: Magnetic resonance imaging and CT (spine): 1. Postoperative changes in the lumbar spine 3 - 5 vertebral body. 2. Degenerative changes in the lumbar spine. 3. Compression changes in the 9 - 12 vertebrae of the chest, with a compression degree of approximately 1/4 to 1/3. Pathological examination results: Degenerated fibrocartilage and a small amount of dead bone, extensive infiltration of inflammatory cells in fibrous connective tissue, partial necrosis, and local granulation tissue formation. Blood routine +CRP (venous blood): white blood cells 10.81 x 109/L, neutrophil percentage 77.8%, whole blood high-sensitivity C-reactive protein 29.56 mg/L, erythrocyte sedimentation rate measurement (ESR): erythrocyte sedimentation rate 87.0 mm/hour, coagulation function: activated partial thromboplastin time 27.1 second, thrombin time measurement 14.2 second, fibrinogen detection 4.64 g/L, D-dimer measurement 3151.51DDU µg/L, inflammatory markers: procalcitonin 0.094 ng/mL, interleukin-6 26.73 pg/mL. Liver function test: total protein 49.9 g/L, albumin 25.7 g/L. Renal function test: creatinine 40.70 µmol/L. Lumbar spine tissue bacterial culture and identification: Salmonella enteritidis, lumbar spine tissue NGS: Salmonella enteritidis.

Conclusions: This article reports a case of Salmonella enteritis infection in the lumbar spine. Salmonella enteritis was quickly and accurately identified by matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS), serum agglutination assay, and next-generation sequencing technology (NGS). Reasonable treatment measures were adopted clinically, and the patient improved and was discharged. I hope that in the future, this case report can provide reference for the clinical diagnosis and treatment of Salmonella enteritis in special parts. Meanwhile, this case confirms that NGS has considerable application prospects in the rapid and accurate diagnosis of pathogens.