Lumbar Spine Infected by Mycobacterium tuberculosis and Cryptococcus neoformans: a Rare Case Report.

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Trifluoromethylations of (Hetero)arenes and Polarized Alkenes Using Trifluoroacetic Anhydride under Photoredox Catalysis.

A novel trifluoromethylation of (hetero)arenes and polarized alkenes using simple trifluoroacetic anhydride (TFAA) as the low price CF3 source under photoredox catalysis was developed without using additives such as bases, hyperstoichiometric oxidant, or auxiliaries. The reaction showed excellent tolerance, including to some important natural products and prodrugs, even on the gram scale and extended to ketones. This simple protocol provides a practical utilization of TFAA. Several perfluoroalkylations and trifluoromethylation/cyclizations were successfully achieved under identical conditions.

Visible-Light-Induced Formation of Thiavinyl 1,3-Dipoles: A Metal-Free [3+2] Oxidative Cyclization with Alkynes as Easy Access to Thiophenes.

A visible-light-induced [3+2] oxidative cyclization of various alkynes with easily available ketene dithioacetals as the previously unknown thiavinyl 1,3-dipoles in the presence of an acridine photosensitizer is reported. A series of multisubstituted thiophenes were achieved regioselectively in ≤98% yields under very mild metal-free conditions without other additives. This reaction could tolerate a wide range of substrates and achieve good efficiency in large-scale syntheses. The reaction mechanism and their applications are described in detail to reveal the reactivity of the new 1,3-dipoles and the selectivity of the reactions.

Photoinduced C(sp2)-H/C(sp2)-H Cross-Coupling of Alkenes: Direct Synthesis of 1,3-Dienes.

A highly concise route to substituted 1,3-dienes from vinylarenes and ketene dithioacetals under photoinduced cross-coupling reaction is described. The reaction proceeded in a highly regio- and stereoselective manner and showed broad functional group tolerance. More than 35 substituted 1,3-dienes were synthesized with good to excellent yields through the construction of the Csp2-Csp2 bond without using noble metal and external oxidants, and natural sunlight could also induce the reaction to afford gram-scale synthesis under ambient conditions.