DIET & NUTRITION 
PATIENT EDUCATION 
OBESITY/WEIGHT MANAGEMENT 
EXERCISE/TRAINING 
LEGAL MATTERS 
GUIDELINES/RECOMMENDATIONS 
A 14-year-old with fever, back pain, and progressive vertebral destruction appeared to have spinal TB in endemic region but anti-tuberculosis therapy failed and imaging showed advancing disease. Surgical biopsy revealed Salmonella Dublin spondylitis, requiring immediate discontinuation of TB drugs and targeted antimicrobial therapy.
🩺 CLINICAL CONSIDERATIONS
- TB-like presentation in endemic regions can delay recognition of invasive non-typhoidal Salmonella causing destructive vertebral osteomyelitis and psoas abscess
- Blood cultures and serum mNGS both negative; only surgical tissue sampling with culture and mNGS identified the causative pathogen
- Radiographic progression despite 4-drug anti-tuberculosis therapy signaled diagnostic error, prompting surgical intervention that established correct diagnosis
- Salmonella Dublin causes invasive infections mimicking TB clinically and radiographically, requiring tissue diagnosis in refractory cases with systemic symptoms
💉 PRACTICE APPLICATIONS
- Obtain surgical tissue for culture and mNGS when empiric anti-tuberculosis therapy shows no clinical response
- Consider invasive non-typhoidal Salmonella in TB-endemic areas with vertebral destruction and negative initial cultures
- Monitor radiographic progression during TB treatment; advancing lesions warrant immediate diagnostic tissue sampling
- Discontinue empiric TB therapy promptly once alternative bacterial pathogen identified through surgical tissue diagnostics
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