Data and methods Patient XX, male, 14 years old, Chengdu, student, was admitted to the hospital with “heel pain for 50 days, fever, cough and sputum for 5 days”. The patient was diagnosed with “traumatic osteoarthritis” at the local hospital and later complained of Achilles tendon tenderness and mild lumbar pain, and was diagnosed with “ankylosing spondylitis”. He was diagnosed as “ankylosing spondylitis”, tested negative for pure protein derivative (PPD) of tuberculosis, and given the tumor necrosis factor alpha (TNFα) antagonist “class K” once 36 days before admission and once 22 days before. 5 days before admission, he had fever, body temperature up to 38℃, cough, yellow sputum, no chest pain and hemoptysis. He was admitted to our hospital for further treatment. He denied any history of tuberculosis. He had received BCG vaccination. History of trauma was denied. No history of smoking, drinking or travel. No family history of tuberculosis. Physical examination: T 37.5℃, a little wet sound in both lungs, no percussion pain in the spine, no redness, swelling or pressure pain in the joints of the body. Auxiliary examination: MRI scan of the thoracic spine showed bone destruction of the T11 vertebral body and swelling of the paravertebral soft tissue. Consider the possibility of spinal tuberculosis with paravertebral abscess formation. Thoracic spine CT and thoracic spine film suggest T11 vertebral body bone destruction, paravertebral cold abscess formation. Chest radiograph: bilateral pulmonary apical tuberculosis (TB) is likely. there is no significant abnormality in T-cell subsets. Blood count: WBC 4.9X10^9/L, N 33.54%, lymphocytes 51.04%, sedimentation 114.0 mm/h. C-reactive protein 42.60 mg/L. Three consecutive sputum smears did not reveal acid-fast bacilli. Sputum culture showed a high amount of mixed clump of Acinetobacter baumannii/calcium acetate complex. After 4 weeks, the patient was transferred to the orthopedic department for trans-anterior thoracoscopic removal of 11 cone tuberculosis lesions, fusion with iliac bone graft and internal fixation with nail bar system. The surgical pathology suggested the formation of tuberculosis granuloma, antacid staining (+), and positive PCR for tuberculosis. More than 10 days after surgery, the patient developed fever and swollen lymph nodes all over the body, and was readmitted to the hospital in February. The patient was re-admitted to the hospital 2 months after surgery. Light pressure pain was observed. A surgical incision of about 5 cm in length was seen on the left side of the chest wall. Wound healing was possible. Auxiliary examination: biopsy of lymph nodes in the neck of our hospital: more inflammatory necrotic material was found, and a small amount of Mycobacterium bovis was detected by antacid staining. It was consistent with tuberculosis. The repeat blood sedimentation was 69.0 mm/h, C-reactive protein (CRP) was 18.4 mg/L, and the tuberculosis antibody test was positive. After admission, he continued anti-tuberculosis treatment with HRE for 11 days, but there was still a trend of increasing lymph nodes throughout the body. After a general discussion in the TB department, drug-resistant TB was considered as a possibility, and an anti-tuberculosis regimen was recommended: 6 months of intensive treatment (pyrazinamide, ricofibric acid, prothiouracil, clarithromycin, butamycin) + 18 months of consolidation treatment (pyrazinamide, ricofibric acid, prothiouracil, clarithromycin), and liver-protective treatment. Repeat spine CT and thoracic spine film showed bone destruction of T10,11 vertebrae, narrowing of the vertebral space, and no loosening or fracture of the internal fixator. The patient’s condition was better than that in the hospital, without fever and night sweats. Physical examination: enlarged lymph nodes were reduced compared with before. Repeat examination: blood routine, liver and kidney function and electrolytes were normal, blood sedimentation 52 mm/h, C-reactive protein 10.3 mg/L was better than at the time of admission, and discharge was granted. Discharge diagnosis: 1 postoperative thoracic 11 vertebral tuberculosis 2 lymph node tuberculosis ((sub-chin, bilateral neck, inguinal, right N fossa) 3 bilateral upper lung secondary type pulmonary tuberculosis Tu (-) retreatment with infection. Out-of-hospital continuation of anti-tuberculosis retreatment after completion of the course of treatment, the review of spinal CT and thoracic spine film suggested no significant changes compared to the postoperative lesions, and the cervical lymph nodes disappeared.