Clin Lab. 2024 Jun 1;70(6). doi: 10.7754/Clin.Lab.2024.240118.
In July 2023, our hospital confirmed one case of lumbar spine infected complicated by Mycobacterium tuberculosis and Cryptococcus neoformans. The patient was admitted due to lower back pain for 1 year and a hard lump for 3 months. Symptoms and signs: Dressing can be seen fixed on the lower back, with severe bleeding. When the dressing is removed, a hard and protruding lump with a size of 6 cm x 8 cm, a sinus tract can be seen near the mass, with a slightly red wound and a sinus depth of about 3 cm. Light red fluid can be seen flowing out. There are no symptoms such as redness, swelling, or heat in the rest of the lower back, and the patient has no other underlying diseases or surgical history.
Lumbar magnetic resonance imaging and lumbar CT examination; Percutaneous puncture lumbar vertebral biopsy was performed, and the biopsy tissue was subjected to pathological examination, mNGS (metagenomic next-generation sequencing), and acid-fast staining; Extract pus from the lump for fungal culture and ink staining, and identify the fungi through MALDI-TOF MS.
Bone destruction and bone marrow edema in the L5 vertebral body, compression of the spinal canal at the L5 vertebral body level; The pathological results of the biopsy tissue indicate granulomatous lesions. The acid-fast staining of the tissue is positive, and the mNGS of the tissue indicates infection with Mycobacterium tuberculosis. A single fungus was cultured from pus and identified by MALDI-TOF MS as Cryptococcus neoformans. Clinically, isoniazid 0.3 g ivgtt + rifampicin 0.45 g qd po + ethambutol 0.25 g qd po + pyrazinamide 0.75 g qd po + fluconazole 0.3 g qd po was administered for treatment. After 11 days, there was slight pain at the incision site, and the original symptoms were significantly relieved. The wound dressing was fixed in place, dry and without obvious exudation. Improved and discharged, followed up for 3 months with no recurrence of the lesion.
mNGS is an effective identification technique that can be used to accurately diagnose suspected infection cases. MALDI-TOF MS has significant advantages over traditional detection methods in shortening detection time. This case achieved satisfactory treatment results for patients through a reasonable treatment plan, which is of great significance for exploring the diagnosis and treatment of similar disease infections.
2023 年 7 月，我院确诊 1 例腰椎感染合并分枝杆菌和新型隐球菌感染的病例。患者因腰痛 1 年，肿物 3 个月入院。症状及体征：可见腰部敷料固定，出血严重。去除敷料后，可见一大小为 6cmx8cm 的硬结凸起，肿物附近可见窦道，伤口微红，窦道深约 3cm，可见淡红色液体流出。其余下腰部无红肿热痛等症状，患者无其他基础疾病或手术史。
腰椎磁共振成像和腰椎 CT 检查；经皮穿刺腰椎活检，对活检组织进行病理检查、宏基因组下一代测序（mNGS）和抗酸染色；从肿块中提取脓液进行真菌培养和墨汁染色，并通过基质辅助激光解吸电离飞行时间质谱（MALDI-TOF MS）鉴定真菌。
L5 椎体骨质破坏伴骨髓水肿，L5 椎体水平椎管受压；活检组织病理结果提示为肉芽肿性病变。组织抗酸染色阳性，组织 mNGS 提示分枝杆菌感染。从脓液中培养出单一真菌，MALDI-TOF MS 鉴定为新型隐球菌。临床给予异烟肼 0.3g 静脉滴注+利福平 0.45g 每日 1 次口服+乙胺丁醇 0.25g 每日 1 次口服+吡嗪酰胺 0.75g 每日 1 次口服+氟康唑 0.3g 每日 1 次口服治疗。治疗 11 天后，切口处稍有疼痛，原有症状明显缓解。伤口敷料固定在位，干燥无明显渗出。好转出院，随访 3 个月，病灶无复发。
mNGS 是一种有效的鉴定技术，可用于准确诊断疑似感染病例。MALDI-TOF MS 在缩短检测时间方面具有明显优势。该病例通过合理的治疗方案为患者取得了满意的治疗效果，对探索类似疾病感染的诊治具有重要意义。
