Cervical brucellar spondylitis with spinal epidural abscess: Two in one involving cervical spine

摘要

Brucellosis is a systemic infectious disease presenting with possible osteoarticular involvement like sacroiliitis,peripheral arthritis, osteomyelitis, bursitis and spondylitis.Here we report a case of brucellar spondylitis involving cervical vertebrae complicated by epidural abscess without neurologicimpairment.A 64 year-old woman with neck pain radiating to the left arm presented with coexisting low-grade fever, night sweats, chills,dorsal pain, arthralgia and fatigue. Musculoskeletal examination revealed tenderness over the cervical spinal processes andbilateral paraspinal muscles. Brucellosis was suspected due to unpasteurised fresh cheese consumption and was confirmed withagglutination tests.X-rays showed increased anterior soft tissue thickness at the C4-7 level and a loss of height of the C6-C7 disc. MRI withgadolinium showed an epidural abscess lesion and diffuse hypointense signal intensity at C6-C7 vertebral end plates without anybony destruction.After 3 months with a combination of streptomycin, rifampicin and doxycycline treatment, all symptoms and signs disappeared,and MR imaging revealed evident narrowing of C6-C7 intervertebral disc space as a sequalae of spondylitis. During the followup of 2 years, no relapse occurred.Since there is no specific symptom or sign of brucellosis, it should be suspected during the course of diagnosis, based on apatient's history, symptoms, radiological findings in regions where brucellosis is endemic.