Brucellar spondylo-discitis with rapidly progressive spinal epidural abscess presenting with sciatica

doi:doi:10.1038/sj.sc.3101938

Abstract

Study design:

Case report.

Objective:

To present a patient with spinal brucellosis, which was initially presented with sciatica and misdiagnosed as a lumbar disc herniation owing to nonspecific neurological and radiological findings. The delay in diagnosis led to rapid progression of the disease and complications.

Setting:

Department of Neurosurgery at a tertiary university teaching hospital (Sutcu Imam University Medical Center in Turkey).

Case report:

A 57-year-old woman with a history of low-back pain for 6 months, fatigue, and severe left-sided sciatica for the last 3 months presented to our hospital. Three months earlier, at another hospital, she had had a negative Rose-Bengal test for brucellosis and a lumbar computed tomography performed at that time showed only minimal L4|[ndash]|5 annular bulging. For 2 months, she was treated with analgesics for |[lsquo]|lumbar disc herniation|[rsquo]| without relief of pain. On presentation to our department, her magnetic resonance imaging (MRI) examination showed edema and minimal annular bulging at L3|[ndash]|4 and L4|[ndash]|5. When her Rose-Bengal test returned positive, she was started on triple antibiotics for presumed Brucella infection. When symptoms and neurologic signs worsened while taking antibiotics, repeat MRI scan showed a spinal epidural abscess at the L4|[ndash]|5 level. Emergent surgery and 8 weeks of antibiotics resulted in cure.

Conclusion:

In areas endemic for brucellosis, subtle historical and exam features should be sought to exclude an infection such as brucellar sponylo-discitis. Appropriate serological tests should be readily available to confirm or exclude this diagnosis in selected patients, to avoid delays in antibiotic treatment.

Keywords:

spinal brucellosis, epidural abscess, lumbar disc herniation, serology

Case Report