Diagnosis and management of spinal tuberculosis combined with brucellosis: A case report and literature review

Abstract

Tuberculosis combined with brucellosis is a very rare condition. Overlapping clinical presentation and laboratory parameters of tuberculosis and brucellosis may lead to misdiagnosis or delayed diagnosis of the condition. The current study presents the case of a 45-year-old male with symptoms of lower back pain, non-tender swelling in the right flank, intermittent hyperpyrexia, sweating, body aches and numbness and weakness of right lower limb. A lumbar computed tomograph (CT) scan and magnetic resonance imaging indicated vertebral destruction and the formation of sequestra and thecal sac compression. Tuberculosis was suspected, but subsequent culture of blood and pus revealed the co-infection of Mycobacterium tuberculosis and Brucella melitensis. The patient was treated with antibiotics, CT-guided percutaneous drainage of the abscess and posterior approach decompression, debridement, instrumentation and fusion. Co-existence of spinal tuberculosis and brucellosis is rare and clinicians should strengthen the awareness of such conditions in similar patients. CT-guided percutaneous drainage is effective in the diagnosis and management of spinal tuberculosis with abscess.

Keywords: brucellosis; percutaneous drainage; posterior debridement; psoas abscess; spinal tuberculosis.

Figure 1.

(A) Lateral radiograph of the lumbar spine revealed a narrowed disc space and spondylitis at the L4-5 level (black arrow). (B-D) Computed tomograph scans demonstrated vertebral destruction, formation of sequestra (white thin arrow), bilateral psoas and right iliac fossa abscesses (white thick arrow). (E) Contrast indicated that the abscesses were clearly peripherally enhanced (white arrow). (F) The magnetic resonance imaging of the T2-weighted fat suppression axial revealed that the abscess had spread into the spinal canal causing thecal sac compression (white arrow).

Figure 2.

Histopathological slide indicating granulomatous inflammation and caseous necrosis (white arrow). Hematoxylin and eosin staining; magnification ×200.