Lumbar Brucella Spondylodiscitis with Extensive Vertebral Abscesses

Abstract

Figures

A](#f1)) and destruction of the L3 and L4 vertebrae ([Figure 1B and C](#f1)). Magnetic resonance imaging showed L3/4 spondylodiscitis ([Figure 1D](#f1)), a massive psoas abscess extending from L3 to the iliac fossa ([Figure 1E](#f1)), and an L3/4 epidural abscess ([Figure 1F](#f1)).

Full text

A 59-year-old woman was referred to the outpatient department, complaining of 2 months of low back pain and intermittent fever. She is a shepherd and lives in a village in the Aksu Prefecture of Xinjiang. She had consumed unpasteurized milk a few weeks before the onset of her symptoms. The spinal physical examination showed impaired sensation below the knees, 4/5 strength in the lower extremities, and weak patellar tendon and Achilles tendon reflexes. Laboratory tests indicated a normal white cell count, an increased erythrocyte sedimentation rate (ESR; 50 mm/hour), and an elevated level of C-reactive protein (CRP; 91 mg/L). The interferon-γ release assay (T-spot test) was negative. The Rose–Bengal test result was positive, and the serum agglutination test showed an increased diluted titer of 1:400. Brucella melitensis was obtained from blood cultures. Computed tomography revealed a collapsed L3/4 intervertebral space (Figure 1A) and destruction of the L3 and L4 vertebrae (Figure 1B and C). Magnetic resonance imaging showed L3/4 spondylodiscitis (Figure 1D), a massive psoas abscess extending from L3 to the iliac fossa (Figure 1E), and an L3/4 epidural abscess (Figure 1F).

Given the intolerable back pain, massive psoas and epidural abscesses, and neurologic deficit, surgical treatment was recommended. The patient underwent a one-stage anterior debridement of the abscesses, interbody bone grafting, and internal fixation, followed by posterior debridement and pedicle screw fixation. The patient’s symptoms significantly improved postoperatively. A histopathologic examination and bacterial cultures confirmed the diagnosis of *Brucella *spondylodiscitis (BS). Anti-brucellosis chemotherapy with doxycycline at a dose of 200 mg/day and rifampicin at a dose of 600 mg/day was administered for 6 months. At the 12-month follow-up, the ESR and CRP values were normal. Magnetic resonance imaging showed that the epidural and paraspinal abscesses were cured (Figure 2).

*Brucella *spondylodiscitis most frequently affects the lumbar spine (81.2%),1 but BS with massive psoas and epidural abscesses is a rare condition. Treatments for BS include medication and surgery.2 Surgical indications include progressive deformity, large abscess, neurological deficit, and intolerable pain.3 After surgery, regular anti-brucellosis chemotherapy and close follow-up are recommended to prevent relapses.