Spinal epidural abscess due to Brucella

Abstract

Background Brucellar spinal epidural abscess (SEA) is a rarely encountered clinical entity during the course of the systemic Brucella infection. Methods We reported 9 patients diagnosed with Brucellar SEA with a mean follow-up of 20 months. Spinal epidural abscess was detected by magnetic resonance imaging in all cases. Brucella diagnosis was established by specific blood tests. Patients were administered antibiotics for a duration of 6 to 12 weeks. Results Spinal epidural abscess was localized in lumbar region in 6 patients, dorsal in 2 patients, and cervical in 1 patient. Abscess mimicked disk herniation clinically in 3 patients. Although neurologic examination was normal in 6 patients, we detected motor deficit in 3 patients. Symptoms regressed in all patients but 1 after the institution of antibiotic regimens, and all recovered fully without any sequel. Surgical drainage of abscess was performed in 1 patient. Conclusions Proper antibiotic regimens in required doses and duration should be the primary treatment in Brucellar SEA. The criteria for terminating antibiotic therapy are clinical recovery and dissolution of abscess images radiologically. Lastly, should any neurologic deterioration be detected during the course of medical treatment, surgical decompression is to be considered.