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A case of systemic brucellosis with spondylodiscitis mimicking postoperative spondylodiscitis after lumbar disc surgery
  1. Paul Riis1,
  2. Abderrahman Machraoui2,
  3. Wolfgang Börm1
  1. 1Neurosurgical Department, Flensburg, Germany
  2. 2Department of Internal Medicine, Flensburg, Germany
  1. Correspondence to Dr Paul Riis, Neurosurgical Department, Knuthstrasse 1, Diakonissenanstalt zu Flensburg, D-24939 Flensburg, Germany; paul.riis{at}gmx.de

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Introduction

Postoperative spondylodiscitis is a well-known complication of lumbar disc surgery, affecting between 0.1 and 1.7% of patients.1 It is usually due to contamination by skin flora. Usual pathogens are Staphylococcus aureus and Staphylococcus epidermidis.

In industrialised countries, brucellosis is a rare condition, almost exclusively found in cattle-exposed patients such as farmers, shepherds and veterinarians. Brucella osteomyelitis is rarer still, although it mostly affects the spine.

History and presentation

A 43-year-old man had undergone dorsolateral transmuscular sequestrectomy and nucleotomy including Nebacetin-irrigation L3/4 for an extraforaminal left-sided herniated lumbar disc (figure 1A). The early postoperative course was uneventful.

Figure 1

(A) CT scan of the left-sided extraforaminal herniated lumbar disc at L3/4. (B) Sagittal and (C) axial T2-weighted MRI scans of the spondylodiscitis L3/4 before therapy showing a high signal intensity of the intervertebral disc L3/4 with obvious involvement of the vertebrae L3 and 4. (D) Sagittal and (E) axial T2-weighted MRI scans 3 months after dismissal showing normal signal intensity of the intervertebral disc and slightly increased signal intensity of the adjacent vertebrae.

Two months later, he appeared with a 4-week history of lower back pain, fever, chills and profuse sweating. The plain x-ray showed no signs of spondylodiscitis, but the initial MRI revealed typical findings of spondylodiscitis at L3/4 (figure 1B, C). The patient was ordered …

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