Total spinal involvement due to delayed diagnosis and treatment of noncontiguous brucellar spondylitis

Abstract

Rational: Brucellosis is a globally prevalent zoonotic disease. Any part of the body can be affected by active brucellosis but osteoarticular involvement are the most common symptoms which was reported to vary from 10% to 85%. The spine is the most common site of brucellosis in the bones. However, noncontiguous brucellar spondylitis is rare, only few cases have been reported in the literature. Patient concerns: A 62-year-old woman with brucellar spondylitis presented with lower back pain and pain in the right lower extremity for six months. Diagnosis: Brucella agglutination test (1:320) and the result of polymerase chain reaction (PCR) confirmed the diagnosis of noncontiguous brucellar spondylitis. Intervention: During hospital stay, the women received intravenous treatment for brucellosis (A combination of doxycycline 200 mg/d, rifampicin 900 mg/d, levofloxacin 0.5 g/QD, and ceftriaxone 2 g/QD was administered for 1 week), The L4-S1 vertebral body was fixed by posterior lumbar debridement. Outcome: Six months after discharge, the follow-up radiographic images showed stable vertebral height and good lumbar stability. She complained no discomfort. Lessons: Multi-level involvement is an exceptional form of brucellar spondylitis. To the best of our knowledge, only few similar cases have been reported. PCR and bacterial culture is necessary for confirmed diagnosis.