SHM Converge Scientific Abstract ePoster Gallery-Case of Brucellosis Spondylodiscitis and Epidural Abscess in Immunocompetent Patient

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A 36-year-old immunocompetent man developed 1.5 months of worsening low back pain and sciatica that progressed rapidly to bilateral leg weakness, inability to walk, and one episode of fecal incontinence. He had no fever or other systemic symptoms. His history was notable for recent immigration from Mexico and later disclosure of eating cheese brought from Mexico, raising concern for unpasteurized dairy exposure.<br /><br />Exam showed lumbosacral tenderness and mild bilateral lower-extremity weakness with left foot drop. ESR was elevated, while CRP, CBC, and BMP were normal. Brucella IgM and IgG serologies were positive. Blood cultures were initially pending but later one of two sets grew Brucella spp after about 7 days. Imaging with CT and MRI showed L5-S1 spondylodiscitis and a multiloculated anterior spinal epidural abscess extending from L4 to S3.<br /><br />He underwent lumbar laminectomy for abscess drainage and spinal revision. Antibiotic treatment included gentamicin for 2 weeks plus doxycycline and rifampin planned for 3–6 months. He improved clinically and was seen by Infectious Disease and Orthopedic Surgery within one month after discharge, with repeat MRI planned to guide treatment duration, though he was later lost to follow-up.<br /><br />The case emphasizes that Brucella can cause vertebral osteomyelitis and spinal epidural abscess even in healthy patients, particularly after exposure to unpasteurized dairy. Diagnosis requires careful exposure history and serologic testing, because blood cultures may be delayed or initially negative. Bone marrow culture is the most sensitive diagnostic test. Prompt prolonged combination antibiotic therapy and surgical intervention when neurologic compromise is present are essential to prevent permanent deficits.

Asset Subtitle

Patricia M. Dillawn

Meta Tag

Author List Doris Lin, Helena Zhang, Patricia M. Dillawn

Category Clinical Vignettes

Concept Brucellosis

Concept Brucella Species

Concept Vertebral osteomyelitis

Concept Discitis-osteomyelitis

Concept Spinal Epidural Abscess

Distinguished Non-Finalist

Presenter Organization Baylor College of Medicine

Presenting Author Patricia M. Dillawn

Track Adult

Keywords

Brucella

spondylodiscitis

spinal epidural abscess

vertebral osteomyelitis

low back pain

sciatica

unpasteurized dairy

blood cultures

doxycycline rifampin

laminectomy

Brucellosis

Brucella Species

Vertebral osteomyelitis

Discitis-osteomyelitis

Spinal Epidural Abscess