Acessibilidade / Reportar erro

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 region11. 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.. Brucella-related epidural abscesses and neurobrucellosis are rare complications with a poor prognosis22. 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.,33. Bouferraa Y, Bou Zerdan M, Hamouche R, Azar E, Afif C, Jabbour R. Neurobrucellosis: Brief Review. Neurologist. 2021;26(6):248-52.. 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
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