A Case of Brucella Spondylodiscitis with Extended, Multiple-level Involvement

Abstract

Brucellosis is a zoonosis that affects several organs and has a protean presentation. The authors report the case of a 61-year-old male patient with brucellar spondylodiscitis involving several vertebrae and a paravertebral abscess localized in the erector spinae muscle. Diagnosis was made by positive blood culture and MRI. No relapse was seen with a combined treatment (doxycycline/rifampin) for 3 months, followed by doxycycline alone for 6 months. Almost all radiologic findings disappeared at the end of a 1-year follow-up without any further treatment.

Spondilodiscite brucellare: aspetti in risonanza magnetica con sequenze convenzionali e sequenze pesate in diffusione

“…We encount≠ered nine and 11 patients with paravertebral and epidural abscess formation, respectively, and ten and eight patients had spinal cord and root compression, respectively. Paravertebral involvement in the erector spinae muscle is an extremely rare finding, which has only been described by Ozden et al [16] and Ozgocmen et al [17] and occurred in one of our patients with immunosuppression. Facet joint involvement has been previously described by Ozaksoy et al [2] as a distinguishing feature of brucellar spondylodiscitis in 27% of patients in their series.…”

Non-pyogenic infections of the spine

“…MRI usually shows vertebral body signal changes without morphological changes with increased signal in the intervertebral disc on T 2 -weighted and contrast-enhanced sequences. A great majority of patients have involvement at only one vertebra level [45], with only a few patients having multilevel involvement [61]. In some cases of Brucella spondylodiscitis, soft tissue involvement without abscess formation and facet joint signal changes following contrast enhancement can be seen [62,63].…”

Brucellosis masquerading as spondylodiscitis with multiple intervertebral disc prolapse

“…Spondylitis occurs usually above 50 years[12] and mostly involves lumbar spine in the form of spondylodiscitis followed by dorsal and cervical spine. Usually monofocal lesions appear but multiple levels contiguous or non-contiguous lesions mimicking tuberculosis can occur[3] but this is exceptionally rare. Only a few cases with multiple level involvements of spine and disc have been described till date.…”

“…The diseases which come in differential diagnosis are tuberculosis, pyogenic infection or a degenerative disease. [23] In brucellosis, spondylitic changes appear in the form of osteophytes on anterior end plate (Parrot beak spine), intact vertebral body with disc gas or discal vacuum on MRI with par spinal soft tissue involvement. In tuberculosis vertebral collapse with gibbus deformity of dorsolumbar spine with psoas abscess formation occur.…”