Brucellar Cervical Spondylodiscitis Complicated by Epidural Abscess and Neurobrucellosis

A 59-year-old woman diagnosis with brucellosis was admitted to our clinic with complaints of severe headache, neck pain, and pain and weakness in the left arm despite receiving treatment for 2 weeks. The patient participated in animal husbandry and had a history of making and consuming cheese from unpasteurized milk. Physical examination revealed a body temperature of 37 °C, painful neck vertebrae on local palpation, weakness of the left arm, and nuchal rigidity. Her white cell count was 6.07 × 10³/µL, C-reactive protein 57 mg/L, sedimentation rate 89 mm/h, Wright agglutination test 1/320, and Brucella IgM 0.40 and IgG 2.18 (cut-off value: 0.9-1.1). Cerebrospinal fluid (CSF) glucose was 64.6 mg/dL (blood glucose 120 mg/dL), microprotein 102.6 mg/dL, and lymphocyte count 4 cells/mm³. The patient was started on doxycycline 2 × 100 mg/day, rifampicin 1 × 600 mg/day, streptomycin 1 g/day, and ceftriaxone 2 × 2 g/day. No regression occurred in the patient’s shoulder and neck pain. The cervical magnetic resonance imaging results are shown in Figure 1. The CSF parameters were normal on day 20. After 6 months of treatment, almost complete regression was observed in abscess formation (Figure 2).

FIGURE 1:
Pre-treatment cervical magnetic resonance images. (a) Non-contrast T1 AG without fat suppression. T1 AG images (b) Fat-suppressed contrast-enhanced; prevertebral abscess (arrow). (c) epidural abscess (dashed arrow).

FIGURE 2:
Post-treatment cervical magnetic resonance images. Almost complete regression can be seen in abscess formations in the prevertebral and anterior epidural distance on sagittal T2 AG (a) and fat-suppressed contrast-enhanced T1 AG (b) images

Brucella spondylodiscitis represents osteoarticular involvement of brucellosis and rarely involves the cervical region¹. Brucella-related epidural abscesses and neurobrucellosis are rare complications with a poor prognosis^2,3. Therefore, spondylodiscitis due to brucellosis, epidural abscess, and neurobrucellosis, which exhibits a wide range of clinical manifestations, should be considered in the differential diagnosis of individuals living in endemic areas.

REFERENCES

• ¹
  Erdem H, Elaldi N, Batirel A, Aliyu S, Sengoz G, Pehlivanoglu F, et al. Comparison of brucellar and tuberculous spondylodiscitis patients: results of the multicenter “Backbone-1 Study”. Spine J. 2015;15(12):2509-17.
• ²
  Pappas G, Papadimitriou P, Akritidis N, Christou L, Tsianos EV. The new global map of human brucellosis. Lancet Infect Dis. 2006;6(2):91-9.
• ³
  Bouferraa Y, Bou Zerdan M, Hamouche R, Azar E, Afif C, Jabbour R. Neurobrucellosis: Brief Review. Neurologist. 2021;26(6):248-52.

• Financial Support: We have not any financial support.

Publication Dates

• Publication in this collection
  20 Feb 2023
• Date of issue
  2023

History

• Received
  06 Nov 2022
• Accepted
  28 Dec 2022