Ergenekon KARAGÖZ, Asım ÜLÇAY, HAKAN ŞİMŞEK, Vedat TURHAN, Hakan ERDEM, Ali ACAR, Oral ÖNCÜL, Levent GÖRENEK

A Rare Case of Brucella Spondylodiscitis Mimicking Lumbar Disc Herniation

A 77-year-old female patient was admitted to our hospital because of low back pain radiating to the right leg for one month. In her history, her abrupt back pain was started in July 2011 and she had been hospitalized in neurosurgery department and after the magnetic resonance imaging (MRI) of the lumbar region, a lumbar disc herniation (LDH) at the L4-L5 level was observed. Serological tests were also performed and showed high levels of Brucella antigen (1/640). The patient was diagnosed as having Brucella infection and therapy consisting of doxycycline and streptomycin was commenced. After 14 days of this combination therapy, streptomycin was altered with rifampicin. Doxycycline and rifampicin were administered for 3 months. At the end of that therapy the patient was free of pain and his physical and neurological examination was found to be normal. In conclusion, brucellar discitis and spondylitis should also be considered in the differential diagnosis of long standing back pain in suspected cases particularly in regions where brucellosis is endemic.

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1. Mousa AM, Bahar RH, Araj GF, Koshy TS, Muhtaseb SA, al-Mudallal DS,Marafie AA. Neurological complications of brucella spondylitis. Acta Neurol Scand 1990;81(1):16-23.

2. Turgut M, Turgut AT, Koşar U. Spinal brucellosis: Turkish experience based on 452 cases published during the last century. Acta Neurochir (Wien). 2006t;148(10):1033- 44.

3. Izcİ Y. Lumbosacral spinal epidural abscess caused by Brucella melitensis. Acta Neurochir (Wien). 2005;147(11):1207-9

4. Kiliç T, Ozer AF, Ozgen S, Pamir MN. Brucellar spondylitis mimicking disc herniation. Case report. Paraplegia 1995;33(3):167-9.

5. Alton GG, Forsyth JR. Brucella. In: Baron S, ed, Medical Microbiology. Galveston: University of Texas Medical Branch. 1996;289-302.

6. Yilmaz C, Akar A, Civelek E, Köksay B, Kabatas S, Cansever T, Caner H. Brucellar discitis as a cause of lumbar disc herniation: a case report. Neurol Neurochir Pol. 2010;44(5):516-9.