CERVICAL BRUCELLOSIS, WITH OR WITHOUT BONE INJURY

Abstract

Brucellosis is a zoonotic infectious systemic, endemic in Albania, which is accompanied by multi-organ involvement. A common complication is also the vertebral affection. Manifestation in the lower lumbar spine is frequently seen, while cervical involvement is more rare. Diagnose of vertebral involvement is difficult because of non-specific clinical symptoms. We present two cases of cervical brucellosis, with various cervical injuries. Spondylodiscitis with epidural abscess were the cervical manifestation in the first patient, which is very rare and a serious complication and the second patient had epidural involvement without spondylodiscitis. The Rose Bengal, Wright test, ELISA were positive for both patients. The cervical injury was confirmed with MRI exams. After prolonged combination therapy with cervical immobilization, the follow up evaluation demonstrated resolution of the cervical injury. Because vertebral destruction is in the base of this complication, early diagnosis of vertebral brucellosis is important to prevent serious morbidity, if diagnosis and treatment are delayed. Standard Brucella tube agglutination (Wright) test is the primary test and should be performed as a first step in the differential diagnosis of spondylodiscitis. An MRI is recommended for early diagnosis of spinal involvement. Medically treatment of cervical brucellosis has a good prognosis with early diagnosis.