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case_images: Flow chart of the entire procedures from onset to cure in the present case.
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case_images: On September 25th, 2021, a 38-year-old Chinese man went to a local hospital for his left lower abdominal pain (Figure 1). Based on the symptoms and the lumbar spine magnetic resonance (MR) images (Supplementary Figure 1) of the patient, the local doctors thought there was a possibility of lumbar (L3/4) tuberculosis (TB).
case_images: X-ray image of pre-operative.
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case_images: X-ray images showed the intervertebral space height between L3 and L4 was decreased (Figure 2). On December 7th, 2021, considering the large vertebral bone defect and high-intensity activity required for his job could lead to spinal instability, an operation was performed (Supplementary surgical Technique and Supplementary Figure 2).
case_images: CT and MR images of lesion site.
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case_images: His lumbar spine CT images showed a large vertebral bone defect at L3 (Figure 3A and D). Subsequent MR imaging revealed disc inflammation and osteomyelitis at L3 and L4 (Figure 3B and C). Of all the intraoperative lesion samples submitted, only mNGS (Supplementary Figure 3) and anaerobic culture confirmed the presence of Eikenella corrodens.
case_images: Record of the patient's armpit temperature during hospitalization and followed-up.
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case_images: However, the patient's condition gradually deteriorated while taking anti-TB drugs and levofloxacin, and the patient had a low-grade fever (Figure 4). Piperacillin Sodium and Tazobactam Sodium (PSTS, 4.5g q8h). PSTS was administered intravenously until the patient was discharged on December 25th, 2021, during which time his infection-related indicators gradually improved (Figures 4 and 5). Under the protection of the waist brace (Supplementary Figure 4B), the bone fusion and spinal stability were good (Figure 7C). His lumbar spine JOA score was 27 and all relevant test indicators had returned to normal (Figures 4-6).
case_images: Record of the patient's inflammatory indicators during hospitalization and followed-up.
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case_images: Piperacillin Sodium and Tazobactam Sodium (PSTS, 4.5g q8h). PSTS was administered intravenously until the patient was discharged on December 25th, 2021, during which time his infection-related indicators gradually improved (Figures 4 and 5). His lumbar spine JOA score was 27 and all relevant test indicators had returned to normal (Figures 4-6).
case_images: Record of the patient's albumin during hospitalization and followed-up.
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case_images: His inflammatory indicators were normal and nutritional status had improved significantly (Figure 6). His lumbar spine JOA score was 27 and all relevant test indicators had returned to normal (Figures 4-6).
case_images: The follow-up X-ray and CT images.
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case_images: X-ray examination of lumbar showed that the lumbar spine (L3/4) had recovered well (Figure 7A and B). Under the protection of the waist brace (Supplementary Figure 4B), the bone fusion and spinal stability were good (Figure 7C).