Lumbar infection caused by Mycobacterium paragordonae: A case report

Abstract

Background: Mycobacterium paragordonae (M. paragordonae), a slow-growing, acid-resistant mycobacterial species, was first isolated from the sputum of a lung infection patient in South Korea in 2014. Infections caused by M. paragordonae are rare.

Case summary: Herein, we report the case of a 53-year-old patient who presented with fever and low back pain. Lumbar nuclear magnetic resonance imaging revealed the destruction of the lumbar vertebra with peripheral abscess formation. After anti-infective and diagnostic anti-tuberculosis treatment, the patient had no further fever, but the back pain was not relieved. Postoperatively, the necrotic material was sent for pathological examination, and all tests related to tuberculosis were negative, but pus culture suggested nontuberculous mycobacteria. The necrotic tissue specimens were subjected to metagenomic next-generation sequencing, which indicated the presence of M. paragordonae. Finally, the infecting pathogen was identified, and the treatment plan was adjusted. The patient was in good condition during the follow-up period.

Conclusion: M. paragordonae, a rare nontuberculous mycobacterium, can also cause spinal infections. In the clinic, it is necessary to identify nontuberculous mycobacteria for spinal infections similar to Mycobacterium tuberculosis.

Keywords: Case report; Lumbar spine infection; Metagenomic next-generation sequencing; Mycobacterium paragordonae; Mycobacterium tuberculosis; Nontuberculous mycobacteria; Spinal infection.

Figure 1

Lumbar spine X-ray showing L1 and L2 vertebral body localized bone destruction with a narrowing of this vertebral space. A: Anteroposterior radiograph of the lumbar spine; B: Lateral radiograph of the lumbar spine.

Figure 2

Magnetic resonance imaging of the lumbar spine showing bone destruction of the L1 and L2 vertebrae, a narrowing of the L1/2 intervertebral space, the destruction of the intervertebral disc, and obvious swelling of the surrounding soft tissues. A: T1-magnetic resonance imaging (MRI) imaging; B: T2-weighted MRI imaging; C: Lumbar coronal MRI image.

Figure 3

Lumbar spine X-rays showing that the L1-L2 interbody internal fixation device was not broken, dislodged, or displaced, and the intervertebral bone graft had healed well. A: Anteroposterior radiograph of the lumbar spine; B: Lateral radiograph of the lumbar spine.

Figure 4

Histological staining of lumbar 1/2 focal tissue. A: Haematoxylin-eosin staining (40 × magnification) showing acute purulent inflammation and inflammatory necrosis; B: Haematoxylin-eosin staining (magnification × 40) showing chronic inflammatory cell infiltration.

Figure 5

Metagenomic next-generation sequencing suggesting the presence of Mycobacterium paragordonae. The total number of bases in the genome of this species was 7224251, the total length of sequence coverage was 618365 bp, the coverage degree was 8.559572%, and the average depth was 1.30x.