Diagnostic challenge of unexpected Salmonella spondylodiscitis mimicking tuberculosis in the context of lumbar canal stenosis: A case report

Background. Salmonella spondylodiscitis is a rare condition that can mimic tuberculous spondylodiscitis, posing diagnostic challenges and affecting treatment selection. Case report. A 64-year-old man was admitted with acute urinary retention following back pain and limb weakness. Lab results showed leukocytosis (11,670/µL) and elevated ESR (68 mm/hr). MRI revealed lumbar stenosis (L4-5) and spondylodiscitis (T9-10). Surgery identified purulent material, and cultures confirmed Salmonella typhi sensitive to ciprofloxacin. Blood cultures and IGRA were negative, while histopathology showed poorly formed granulomas. A follow-up Widal test was positive. Targeted antibiotics and staged surgery led to complete neurological recovery 15 months after the second procedure for severe lumbar stenosis. Conclusions. Surgery enables a definitive diagnosis and targeted therapy for Salmonella spondylodiscitis, leading to resolution of severe spinal pain and complete neurological improvement in long-term follow-up.