Concurrent Presentation of Neurobrucellosis and Spinal Cyst Hydatid: A Case Report

Abstract

Introduction: Brucellosis and cyst hydatid are highly endemic to Turkey. Although these diseases are mostly seen separately, it is also possible to see them together in the same patient. In this case report, we present a patient diagnosed with neurobrucellosis and vertebral cyst hydatid at the same time. Case report: A thirty-five-year-old woman presented with progressive weakness, and numbness in both the legs, headache and fever. The patient came from a province where brucellosis was endemic and her Brucella agglutination tests were positive. The abscess formation encountered in her spinal MRI and milimetric hyperintense lesions on T2-weighted images in white matter in her cranial MRI are interpreted as different presentations of brucellosis. After antibiotic therapy for brucellosis, cranial symptoms dramatically improved. Since the vertebral lesion persisted despite of the medical therapy, it was operated and the pathology of the lesion was reported as hydatid cyst. Discussion: Spinal cyst hydatid is the most common bone involvement of cyst hydatid and it is usually difficult to distinguish from other infectious diseases such as tuberculosis, brucellosis and chronic osteomyelitis. Although very rare, spinal cyst hydatid might be accompanied by a secondary infection and present like an abscess, making the differential diagnosis almost impossible. In such cases histopathological evaluation is extremely important. Brucellosis is another disease commonly encountered in Turkey and the other Mediterranean countries. Inflammation, vascular insult and white matter changes are the imaging abnormalities encountered in neurobrucellosis. After appropriate therapy, complete clinical and radiologic improvement is possible. Brucellosis and cyst hydatid might be encountered in the same patient, especially in endemic areas. In our case, neurobrucellosis and spinal hydatid cyst presented at the same time, making the differential diagnosis highly difficult. Conclusion: Hydatid cyst and brucellosis may present at the same time but in different ways. In diagnosis process, if we try to explain all symptoms and lesions with the diagnosis of hydatid cyst or brucellosis solely, we may end up missing one of them.