Spondylodiscitis with a psoas abscess - not a case of tuberculosis

Abstract

Background: Brucellosis is a zoonotic infection, commonly presenting with osteoarticular involvement. Spinal brucellosis occurs in up to 65% of affected cases, but the occurrence of a psoas abscess is rare, and may mislead the clinician to an alternative diagnosis such as tuberculosis (TB). Case Presentation: Our patient presented with history of fever and lower backache. On evaluation, he was found to have L1-L2 spondylodiscitis with an associated large left psoas abscess. Given the endemicity of TB in India, it was the first considered differential diagnosis. The abscess fluid culture, however, grew Brucella melitensis. On carefully reviewing his history, it was found that the patient had contact with goats as a part of his occupation, explaining the source of the Brucella infection. Conclusion: Brucellosis must be kept in mind as a differential diagnosis for spondylodiscitis even in the occurrence of psoas abscess, a rarity, as seen in this case - in the background of relevant contact history and endemicity.