Multidrug-resistant (MDR) Salmonella Typhi spondylodiscitis with vertebral collapse: a case report

Introduction and importance Spondylodiscitis is an uncommon spinal infection that remains diagnostically challenging because of its non-specific symptoms and radiological overlap with tuberculosis and neoplasms. Among these, infections caused by Salmonella Typhi are extremely unusual, and the case becomes even more challenging when multidrug resistance (MDR) is present.Presentation of case We describe a 49-year-old woman with diabetes and hypertension who presented with persistent back pain following an episode of enteric fever. Imaging showed spondylodiscitis with vertebral collapse, initially suspected as tuberculosis or metastasis. A mammogram and tuberculosis (TB) workup were negative. Definitive diagnosis was only achieved during surgery. Intraoperative biopsy and culture confirmed Salmonella Typhi, resistant to multiple antibiotics but sensitive to imipenem and azithromycin. Targeted therapy led to clinical improvement.Clinical discussion This case underlines the diagnostic difficulty of spinal infections, where radiology alone cannot differentiate between infection and malignancy. Surgical biopsy and culture remain essential, aligning with current Infectious Diseases Society of America (IDSA) and National Institute for Health and Care Excellence (NICE) recommendations.Conclusion Multidrug-resistant Salmonella Typhi spondylodiscitis is exceptionally rare. Early tissue diagnosis and tailored therapy are key to achieving favorable outcomes.