Spinal Brucellosis: A Case Report
The most common location of infection of brucellosis is the musculoskeletal system. It is estimated that the spine is involved in 2–54% of brucellosis infections, with the lumbar spine most commonly affected. A 65-year-old male presented with a history of back pain with a low-grade fever for 3 weeks. His back pain was located in the mid-dorsal region, which was purely mechanical in nature (pain increased on movements and coughing) and did not radiate along his ribs. It was not associated with any neurological symptoms such as tingling, numbness, imbalance, bowel/bladder dysfunction, or weakness in his lower extremities. The severity of pain was gradually increasing from 2/10 to 7/10 on VAS scale, despite conservative treatment by his primary care physician. His clinical picture was further complicated by a significant history of 40 pounds of weight loss over the past few months. At baseline, his medical history was significant for hypertension, hypercholesterolemia, and Type II diabetes. On examination, the patient had localized tenderness around T8-9 level without any deformity or swelling. The patent’s neurological examination did not reveal any abnormalities.

The patient was referred for further treatment and evaluation for a potential infection versus malignancy. The patient’s labs were significant for elevated inflammatory markers: Erythrocyte sedimentation rate of 45 and C-reactive protein of 2.1. Notably, the patient had traveled approximately 1 year ago to Mexico to work as a meat slaughterer. Denied any bowel or bladder issues. Denied any current chest pain, abdominal pain, or shortness of breath. Denied any difficulty walking or ambulating. The patient was ultimately told to come to the ED for a workup of his discitis and possible malignancy. On arrival to the emergency department, blood cultures were obtained and the patient was scheduled for a core needle bone biopsy of T9 as well as a core needle biopsy of the T8-T9 disc space, performed by the interventional radiology service.

While awaiting the results of the biopsy, a CT scan was ordered for further workup and evaluation of the patient’s pathology. While admitted, more detailed interviewing ultimately revealed the patient’s work within a Mexican slaughterhouse and regular consumer of unpasteurized Mexican cheeses. With his recent travel, professional exposure, and MRI findings, tuberculosis or Brucella discitis remained at the top of the differential diagnoses.