A case of brucellar spondylitis with lumbar spondylolisthesis

A 46-year-old man was hospitalized with a 6-month history of severe low back pain in addition to weight loss, fatigue, and intermittent febrile symptoms for the past 4 weeks. Physical examination revealed painful and restricted low back movement. His temperature was 37.5℃. Laboratory values were as follows: white blood cell count: 9,600/mm³, hemoglobin: 13.5g/dl, erythrocyte sedimentation rate: 45mm/h, and C-reactive protein: 58mg/L. The Rose-Bengal test was (++), and the Brucella agglutination test was positive with a titer of 1:320. Computed tomography (CT) revealed intervertebral destruction and narrowing at L4-5 and I° lumbar spondylolisthesis with posterior displacement¹. There was isthmic spondylolisthesis, and there was marginal damage of the centrum as well as hyperostosis osteosclerosis. The margin of the centrum showed lace-like changes (Figure A and Figure B). Magnetic resonance imaging (MRI) showed signs compatible with osteomyelitis of the L4 and L5 vertebral bodies with accompanying discitis. L4-5 intervertebral disc tissues were hypointense, heterogeneous, and heterogeneous on T1 weighted imaging (T1WI), T2 weighted imaging (T2WI), and Short time inversion recovery (STIR) MRI images, respectively (Figure A and Figure C). Antimicrobial therapy was continued for 6 weeks. Surgical intervention was planned for excision of the lesion and reduction of the spondylolisthesis^2,3. Histopathological examination revealed tissular and cellular hyperplasia, a proliferating nodule, and granuloma in the focus. Giemsa staining showed positive Brucella (Figure B). On the control X-ray after surgery, the intervertebral height had been restored, and the lumbar spondylolisthesis was reduced (Figure C).

FIGURE A:
CT revealed intervertebral destruction and narrowing at L4-5, and I° lumbar spondylolisthesis with posterior displacement (arrow in FIGURE A-a). There was marginal damage of the centrum as well as hyperostosis osteosclerosis. The margin of the centrum showed lace-like changes (arrow in FIGURE A-b). MRI revealed L4-5 intervertebral disc tissues, and the L4-5 vertebral bodies were hypointense, heterogeneous, and heterogeneous on T1WI, T2WI and STIR images, respectively (arrow in FIGURE A-c). CT: computed tomography; MRI: magnetic resonance imaging; T1WI: T1 weighted imaging; T2WI: T2 weighted imaging; STIR: Short time inversion recovery.

FIGURE B:
Giemsa staining (arrow) showed positive Brucella (×1,000).

FIGURE C:
Postoperative X-ray revealed that the intervertebral height had been restored, and the lumbar spondylolisthesis was reduced. L: the left.

Acknowledgments

The authors thank the participants for making this study possible. In addition, we thank Dr. Jun Zhao, PI of Beijing JM Stem Cell Technology Co. Ltd., for improving the overall readability of this manuscript.

REFERENCES

• ¹
  Ozerbil OM, Ural O, Topatan HI, Erongun U. Lumbar spinal root compression caused by Brucella granuloma. Spine. 1998;23(4):491-3.
• ²
  Ulu-Kilic A, Karakas A, Erdem H, Turker T, Inal AS, Ak O, et al. Update on treatment options for spinal brucellosis. Clin Microbiol Infect. 2014;20(2):O75-82.
• ³
  Guerado E, Cerván AM. Surgical treatment of spondylodiscitis. An update. Int Orthop. 2012;36(2):413-20.

Publication Dates

• Publication in this collection
  Nov-Dec 2017

History

• Received
  14 Dec 2016
• Accepted
  06 Mar 2017