Abstract
BackgroundBrucellosis is an anthropozoonosis. It is an endemic disease in the Mediterranean basin. The clinical presentation is polymorphic. The osteoarticular form is the most frequent of the focal forms affecting mainly the spine. In our endemic context, the diagnosis can lead to confusion with tuberculosis.Case presentationWe report a case of brucellar spondylodiscitis treated initially as tubercular spondylodiscitis with a good initial evolution. Then, the diagnosis was rectified towards a Brucella origin, after a clinical and biological relapse. Diagnostic confirmation was based on the isolation of Brucella spp in the disco-vertebral CT-guided biopsy and the positive Brucella serology. Then, the patient was put on three antibacterial treatments with doxycycline, rifampicin, plus streptomycin over a period of 6 months with a good evolution.ConclusionBrucellar spondylodiscitis is still common in the Maghreb. It is generally insidious and leads to a delay in diagnosis. The clinician must always mention it when faced with spondylodiscitis in an endemic country and ask for brucella serology.
Highlights
Brucellar spondylodiscitis is still common in the Maghreb
The clinician must always mention it when faced with spondylodiscitis in an endemic country and ask for brucella serology
Brucellosis is transmitted to humans either directly through direct contact with animals infected with brucella bacteria or indirectly through the consumption of unpasteurized dairy products [2]
Summary
Human brucellosis is an anthropozoonosis that causes significant morbidity worldwide with more than 500,000 new cases per year [1, 2]. We report a case of double-stage brucellar spondylodiscitis affecting the thoracic spine. Case presentation A 65-year-old man with a history of poorly controlled type 2 diabetes mellitus (HbA1C: 8.8%) on metformin and chronic smoking with 40 packs per year. One month before his admission, he presented with inflammatory back pain which was initially treated by a general practitioner as severe osteoarthritis without improvement. The patient claimed that he lived on a farm with a regular intake of unpasteurized milk and frequent occurrence of cow abortion His wife’s brucella serology was positive but without any clinical symptoms. Thoracic and lumbar MRI had objectified the D5–6 vertebral body and intervertebral disc with sequellar lesions, and the posterior epidural abscess in the spinal canal had disappeared (Fig. 5)
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