Multiple level spondylodiscitis with presacral abscess in spinal brucellosis: a rare presentation

  • Authors

    • Lobo Alexander Narayana Hrudayalaya,Mazumdar Shaw medical centre ,No 258/A,Bommasandra industrial area ,Anekal taluk,Bangalore-560099
    • Sachin Adukia Narayana Hrudayalaya,Mazumdar Shaw medical centre ,No 258/A,Bommasandra industrial area ,Anekal taluk,Bangalore-560099
    • Jignesh Prajapati Narayana Hrudayalaya,Mazumdar Shaw medical centre ,No 258/A,Bommasandra industrial area ,Anekal taluk,Bangalore-560099
    2017-06-29
    https://doi.org/10.14419/ijm.v5i2.7833
  • Brucella Melitensis, Blood Culture, MRI, Multi-Level Spondylodiscitis, Prevertebral Sacral Abscess

  • Abstract

    Importance: We report an unusual presentation of spinal brucellosis involving multilevel spondylodiscitis, prevertebral sacral abscess and isolation of Brucella using a low-yield test like blood culture. Timely identification helped in dispensing the appropriate antibiotic regimen.

    Observation:Detailed history against an endemic background may give clues to diagnosis of brucellosis. A middle aged farmer from rural India with exposure to cattle excreta presented with severe lower backache and asymmetric paraparesis. Examination revealed proximal lower limb weakness, sensory deficits over L1-L2 dermatomes, sensory level at L1 vertebral level and lumbosacral spinal tenderness with paravertebral muscle spasms. MRI spine with contrast showed multi-level infective spondylodiscitis with a prevertebral sacral abscess. Blood culture helped isolate Brucella melitensis after 8 days. Following this the antibiotic regimen was modified to a twelve month triple therapy with rifampicin, doxycycline and double strength cotrimoxazole.

    Conclusions and Relevance: Longstanding backache with fever in endemic areas should trigger a differential diagnosis of spinal brucellosis. Though newer diagnostic techniques like ELISA, MRI and agglutination tests are being increasingly used, isolation of Brucella on culture media is still a vital investigation. Diagnosis of brucellosis is vital owing to its potential treatability.

  • References

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  • How to Cite

    Alexander, L., Adukia, S., & Prajapati, J. (2017). Multiple level spondylodiscitis with presacral abscess in spinal brucellosis: a rare presentation. International Journal of Medicine, 5(2), 169-171. https://doi.org/10.14419/ijm.v5i2.7833

    Received date: 2017-05-23

    Accepted date: 2017-06-17

    Published date: 2017-06-29