PMC8085699_01
Spinal MRI findings of the patient. (A1, A2) Spinal MRI on day 1 shows a fresh compression fracture (white arrow in A2) with an area of increased signal intensity (white arrowhead in A2) suspected to be a hematoma around the L1 vertebral body. (B1, B2) Spinal MRI on day 15 shows the development of the area (yellow arrowheads) suspected to be an infection around the T12 and L1 vertebral bodies. MRI, magnetic resonance imaging.
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Magnetic resonance imaging (MRI) showed a fresh compression fracture with an area of increased signal intensity area suspected to be a hematoma around the L1 vertebral body (Fig. 1; A1, A2). The following MRI on day 15 revealed increased signal intensity area around the T12 and L1 vertebral bodies (Fig. 1; B1, B2) at the compression fracture site.
Chest CT findings on admission. Chest CT on day 1 shows bilateral airspace opacities (white arrow) with thickned bronchial walls (red arrow) and interlobular septa (yellow arrow). Additionally, consolidation is identified in the posterior lower fields (red arrowhead) with bilateral pleural fluid (yellow arrowheads). CT, computed tomography.
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Chest computed tomography (CT) showed bilateral airspace opacities with thickened bronchial walls and interlobular septa predominantly in the posterior and lower fields and bilateral pleural fluid (Fig. 2).
Microbiological findings of positive blood cultures. (A) Gram staining (x1000) shows large gram-negative rods (yellow arrow). (B) SSB agar medium shows black-pigmented colonies. (C) TSI agar reveals blackening of the bottom due to H2S production. (D) Antimicrobial susceptibility testing resulted in susceptibility to ciprofloxacin according to MIC <= 0.25 mug/mL by VITEK II (bioMerieux). However, E-test  (bioMerieux) revealed 0.094 mug/mL as the MIC of ciprofloxacin, and the disk method showed resistance to ciprofloxacin, which were interpreted as non-susceptibility to ciprofloxacin in accordance with CLSI document. SSB, Salmonella Shigella bromcresol purple; TSI, triple sugar iron; MIC, minimum inhibitory concentration; CLSI, Clinical and Laboratory Standards Institute.
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Blood cultures results became positive after 1-day incubation, and gram-negative rods were seen (Fig. 3A). Tokyo, Japan) showed black-pigmented colonies (Fig. 3B) and triple sugar iron (TSI) agar slant (Nissui Pharmaceutical Co., Ltd., Tokyo, Japan) revealed gas and blackening of the bottom due to H2S production (Fig. 3C). The VITEK  Therefore, we continued with intravenous ceftriaxone for 28 days followed by oral sulfamethoxazole/trimethoprim 1600 mg/320 mg daily for 8 weeks according to susceptibility testing (Fig. 3D).