Brucella infection of the thoracic vertebral arch presenting with an epidural abscess: a case report

Abstract

Introduction: Although Brucella spondylitis and Brucella discitis have been frequently reported, Brucella infection of the vertebral arch is rare and has not been previously described. We present the first case of Brucella infection of the thoracic vertebral arch with epidural abscess formation and discuss the clinical key points.

Case presentation: A 57-year-old man of Han nationality with a history of contact with an isolated sheep stomach 2 months previously was admitted with an undulant fever, night sweats, back pain, and weakness. Thoracic magnetic resonance imaging showed laminar destruction of T9 and an epidural abscess at the T9 to 10 level with significant cord compression. Diagnosis of Brucella infection of his vertebral arch was confirmed by a positive blood culture with growth of Brucella melitensis. Total laminectomy, abscess cleansing, and percutaneous pedicular screw fixation was performed initially, followed by antibiotic treatment with a combination of doxycycline and rifampin for 4 months. Recovery was confirmed by clinical, magnetic resonance imaging, and blood culture findings.

Conclusions: This is an unusual case of Brucella infection of the vertebral arch with epidural abscess formation. Effective antibiotic therapy of a sufficient duration and timely performance of surgical treatment are the key points in management of such cases.

Fig. 1

Magnetic resonance imaging of the thoracic vertebra. a Contrast-enhanced T2-weighted sagittal scan demonstrates a high-signal lesion behind the dural sac at the T8–9 level. b T1-weighted sagittal scan shows that the lesion has an area of moderate signal intensity and low-signal spots. c T2-weighted axial scan shows a high-signal area in both the vertebral canal and paravertebral muscle. The epidural abscess (single-headed arrow) is behand the spinal cord and dural sac

Fig. 2

Positron emission tomography-computed tomography scan of the total body. Radionuclide concentration (single-headed arrow) was detected at the vertebral arch of T9

Fig. 3

Computed tomography scan of the thoracic vertebra. A destructive focus (single-headed arrow) in the bilateral vertebral plates and transverse processes was detected