Brucellosis with cervical vertebrae and pulmonary involvement: A rare case

Abstract

The spine is the most common site of musculoskeletal involvement of brucellosis. However, there is no case report presented in the literature of both cervical vertebrae spondylodiscitis and pulmonary involvement of brucella. We reported a 52-year-old woman complaining for one month of fever with rigors, fatigue, malaise, pain on the neck and arm, and sweating. The Wright agglutination test for brucella was positive at titers of 1/640. MRI of the cervical vertebrae was consistent with spondylodiscitis and paravertebral and epidural abscesses. Ground glass opacity was seen in the left upper lobe on CT scanning of the chest. Percutaneous image-guided biopsy was performed and Brucella melitensis was isolated. The patient was treated with streptomycin for 3 weeks, plus doxycycline and rifampicin for 3 months. We recommend tissue culture for brucella patients with lung lesions. Isolation of the microorganism from a biopsy material provides conclusive evidence. J Microbiol Infect Dis 2015;5(4): 173-175

Key words: Bacterial infection, brucellosis, cervical vertebrae, pulmonary involvement, spondylodiscitis

Keywords

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References

1. Ulu-Kilic A, Karakas A, Erdem H, et al. Update on treatment
2. options for spinal brucellosis. Clin Microbiol Infect 2014;20:O75-82.
3. Pappas G, Bosilkovski M, Akritidis N, et al. Brucellosis and the
4. respiratory system. Clin Infect Dis 2003;37:e95-99.
5. Hatipoglu CA, Bilgin G, Tulek N, Kosar U. Pulmonary involvement
6. in brucellosis. J Infect 2005;51:116-9.
7. Gouliouris T, Aliyu SH, Brown NM. Spondylodiscitis: update on
8. diagnosis and management. J Antimicrob Chemother 2010;65 Suppl 3: iii11-24.

9. Ulu-Kilic A, Metan G, Alp E. Clinical presentations and diagnosis
10. of brucellosis. Recent Pat Antiinfect Drug Discov2013;8:34-41.
11. Modic MT, Feiglin DH, Piraino DW, et al. Vertebral osteomyelitis:
12. assessment using MR. Radiology 1985;157:157-166.
13. Chew FS, Kline MJ. Diagnostic yield of CT-guided percutaneous
14. aspiration procedures in suspected spontaneous infectious diskitis. Radiology 2001;218:211-214.
15. Enoch DA, Cargill JS, Laing R, et al. Value of CT-guided biopsy
16. in the diagnosis of septic discitis. J Clin Pathol 2008;61:750-753.
17. Nourbakhsh A, Grady JJ, Garges KJ. Percutaneous spine biopsy:
18. a meta-analysis. J Bone Joint Surg Am 2008;90:1722-1725.
19. Isik HS, Cagli S, Zileli M. Percutaneous Biopsy of the Spine:
20. Analysis of 84 Cases. J Neurologic Scien 2012; 29:258-265.
21. Kim BJ, Lee JW, Kim SJ, et al. Diagnostic yield of fluoroscopy-guided biopsy for infectious spondylitis. AJNR Am J Neuroradiol
22. ;34:233-238.
23. Erdem H, Inan A, Elaldi N, et al. Respiratory system involvement
24. in brucellosis: the results of the Kardelen study. Chest 2014;145:87-94.
25. Jaen Aguila F, Vargas-Hitos JA, Esteva Fernandez D,Jimenez Alonso J. A farmer with chest pain and lung nodules.Cleve Clinic J Med 2012;79:465-467.
26. Ozden M, Demirdag K, Kalkan A, et al. A case of brucella
27. spondylodiscitis with extended, multiple-level involvement.South Med J. 2005;98:229-231.
28. Ulu-Kilic A, Sayar MS, Tütüncü E, et al. Complicated brucellar
29. spondylodiscitis: experience from an endemic area.Rheumatol Int. 2013;33:2909-2912.