Noncontiguous multiple-level brucellar spondylitis with subsequent relapse

A 65-year-old man was admitted to hospital with a 2-year history of thoracic and lower back pain, weight loss, fatigue, and intermittent fever. Lumbar and thoracic movements were painful and restricted; his temperature was 38.5^oC. The erythrocyte sedimentation rate, C-reactive protein concentration, Rose-Bengal staining, and Brucella agglutination test were 86mm/h, 116mg/L, (++), and positive (1:320), respectively. Magnetic resonance imaging (MRI) showed that T12-L1 and L4-L5 disks and vertebral bodies were hypointense on T1 weighted-imaging (T1WI) and heterogeneous on T2WI and short-T1 inversion recovery (STIR)^1-3 (Figure A: a, b and c).

A combination of doxycycline, rifampin, and streptomycin was administered for 6 weeks, and the lesion was surgically excised. Antimicrobial therapy was discontinued after 3 months. Radiographs revealed recovery of intervertebral height and stabilization of the lumbar vertebrae post-surgery (Figure B: a, b, c and d). MRI showed no signal intensity involving the T12-L1 and L4-L5 disks and vertebral bodies. Relapse was observed at the end of the sixth month; his neck was stiff, with fixed flexion. Computed tomography (CT) revealed intervertebral destruction and narrowing at C7-T1. There was marginal damage of the centrum, with lace-like changes, hyperostosis, and osteosclerosis (Figure C: a, b, c, d and e). MRI showed that C7-T1 disks and vertebral bodies were hypointense on T1WI, heterogeneous on T2WI, and heterogeneous on STIR (Figure C: f, g and h).

FIGURE A:
Magnetic resonance imaging showed that the T12-L1 and L4-L5 disks and vertebral bodies were hypointense (a), heterogeneous (b), and heterogeneous (c) on T1 weighted-imaging, T2 weighted-imaging, and Short-T1 inversion recovery, respectively.

FIGURE B:
Postoperative radiograph revealing recovery of intervertebral height, and stabilization of the lumbar vertebrae (a,b,c,d). L: the left.

FIGURE C:
Computed tomography revealed intervertebral destruction and narrowing at C7-T1. There was marginal damage of the centrum, with lace-like changes, hyperostosis, and osteosclerosis (a,b,c,d,e). Magnetic resonance imaging showed that C7-T1 disks and vertebral bodies were hypointense (f), heterogeneous (g), and heterogeneous (h) on T1 weighted-imaging, T2 weighted-imaging, and short-T1 inversion recovery, respectively. CT: computed tomography; MRI: magnetic resonance imaging; T1WI: T1 weighted-imaging; T2WI: T2 weighted-imaging; STIR: Short-T1 inversion recovery.

Acknowledgments

The authors thank the participant for making this study possible.

REFERENCES

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  Mrabet D, Mizouni H, Khiari H, Rekik S, Chéour E, Meddeb N, et al. Brucellar spondylodiscitis affecting non-contiguous spine levels. BMJ Case Rep. 2011;2011.pii: bcr0120113788.
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  Charalambides C, Papademetriou K, Sgouros S, Sakas D. Brucellosis of the spine affecting multiple non-contiguous levels. Br J Neurosurg. 2010;24(5):589-91.

Publication Dates

• Publication in this collection
  Jul-Aug 2018

History

• Received
  16 Apr 2017
• Accepted
  15 Dec 2017