Objective: We present the case of a 26-year-old male with severe spinal tuberculosis of the thoracolumbar region. The patient suffered from worsening back pain over five years, initially responding to over-the-counter analgesics. Despite being proposed surgery in 2019, the patient refused the intervention and subsequently experienced significant disease progression. Methods: Upon re-presentation in 2022, mild involvement of the T12-L1 vertebrae was recorded by imaging, leading to a percutaneous needle biopsy which confirmed tuberculosis. Despite undergoing anti-tuberculous therapy for one year, the follow-up in 2024 revealed extensive infection from T10 to S1, with large psoas abscesses and a pseudo-tumoral mass of the right thigh. The patient was ultimately submitted to a two-stage surgical intervention: anterior resection and reconstruction of T11-L1 with an expandable cage, followed by posterior stabilization from T8-S1. Results: Postoperative recovery was uneventful, with significant pain relief and no neurological deficits. The patient was discharged on a continued anti-tuberculous regimen and remains under close surveillance. Conclusions: This paper presents details on the challenges of diagnosis and management of severe spinal tuberculosis, with emphasis on the importance of timely intervention and multidisciplinary care.

Periprosthetic joint infection (PJI) caused by Streptococcus bovis (S. bovis) is rare but clinically significant due to its established association with colorectal neoplasia. Early recognition and interdisciplinary management are essential to ensure favorable outcomes. We report the case of a 68-year-old woman who presented with a chronic fistula and signs of active infection 20 years after uncemented total hip arthroplasty. Cultures from the wound identified S. bovis, prompting further evaluation. Imaging and laboratory tests supported a diagnosis of chronic PJI. A two-stage revision was performed, beginning with implant removal, debridement, and placement of a vancomycin/gentamicin-loaded spacer. Given the pathogen’s known link to gastrointestinal malignancy, the patient underwent colonoscopy, which revealed a tubulovillous adenoma with carcinoma in situ. Surgical resection was performed with curative intent. Six months later, the patient underwent successful reimplantation. At three-month follow-up, clinical and radiographic assessments showed favorable recovery. This case reinforces the importance of gastrointestinal screening in patients with S. bovis PJI, as early detection of associated colorectal lesions may impact treatment strategies and prognosis.