Abstract
IntroductionBrucellar epidural abscess is rare but potentially fatal medical entity and very few cases have been reported so far. Whilst in developed countries, cases of brucellar spondylitis and epidural abscess are unusual, since brucellosis has practically been eradicated in animals, in Greece it is one of the most frequent zoonosis. By reporting this case report we want to stress out the importance of early diagnosis and management and also that physicians should keep an open mind and high index of suspicion especially in regions where brucellosis is endemic or when their patients have traveled to these areas and have consumed unpasteurized dairy products.Case presentationWe present the case of a 41-year-old male Caucasian farmer complaining of acute, progressively worsening low back pain of five days duration. Fever with rigors, malaise and profuse night sweating were added to the symptoms, two days before admission. Magnetic Resonance imaging clearly showed the lesion and blood and tissue cultures were positive for Brucella melitensis.ConclusionSpinal epidural abscess is a rare condition, difficult to diagnose, may be complicated by potentially disastrous neurological or vascular complications, and it can be fatal if left untreated. Patients complaining of fever and back pain, particularly in endemic areas should be investigated as possible cases of brucellosis and MRI is the method of first choice in the diagnostic process. Neurological dysfunction is often disproportionate to the observed degree of compression. A delay in diagnosis or surgical treatment may result in deleterious sequelae such as permanent paralysis or even death for patients with spinal epidural abscess.
Highlights
Brucellar epidural abscess is rare but potentially fatal medical entity and very few cases have been reported so far
Cases of brucellar spondylitis and epidural abscess are unusual, since brucellosis has practically been eradicated in animals, in Greece it is one of the most frequent zoonosis
By reporting this case report we want to stress out the importance of early diagnosis and management and that physicians should keep an open mind and high index of suspicion especially in regions where brucellosis is endemic or when their patients have traveled to these areas and have consumed unpasteurized dairy products
Summary
Spinal epidural abscess is a rare condition, difficult to diagnose, may be complicated by potentially disastrous neurological or vascular complications, and it can be fatal if left untreated. Case presentation A 41-year-old male Caucasian farmer was admitted to our hospital complaining of acute low back pain of five days duration. T1-Weighted Spin-echo (SE) sagittal images, a fluid collection in the posterior epidural space with low signal intensity and anteriorly compressing the dorsal sac was detected. On the T2-Weighted SE sagittal sections, increased signal intensity of the fluid collection as well as the L5 and S1 vertebral bodies and the L5-S1 inter-vertebral disk were demonstrated. Following Gd administration, there was marked enhancement of the L5 and S1 vertebral bodies, the L5-S1 inter-vertebral disk and the epidural fluid collection, consistent with spondylodiskitis and abscess formation at the L5-S1 level (Figure 2). Patient was operated on the 5th hospital day and a broad L5 laminectomy was performed with complete abscess removal and decompression of the S1 nerve root. Patient’s post-operative course was uneventful and he was discharged seven days after surgery
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