Case Report: Brucellar Spondylodiscitis and Psoas Abscess

1University of California, San Diego, Medical Center, San Diego, CA

Meeting: Hospital Medicine 2011, May 10-13, Dallas, Texas.

Abstract number: 248

Case Presentation:

This is a 71‐year‐old Mexican American woman who was admitted with a 2‐month history of progressively worsening lower back pain, weight loss, and night sweats. She was treated with ketorolac injections in Mexico without improvement. She traveled frequently between her home in northern Baja Mexico and San Diego, where her family was residing. While in Mexico, she consumed unpasteurized milk and cheese purchased from itinerant vendors. The remainder of her medical, social, and family history was unremarkable. Physical examination was significant for temperature on admission to 101.9°F, tenderness over the lumbar spine and paraspinous muscles, and intact neurologic examination. Laboratory analysis showed unremarkable serum chemistries, normal liver enzymes, a normal white blood cell count, mild anemia, and an elevated C‐reactive protein, to 9.7 mg/dL. Lumbar spine radiographs showed osseous destruction of the L1–L2 end plates, worrisome for an infectious etiology. CT scans of the lumbar spine showed osseous destruction of L1 and L2 with associated severe spinal canal stenosis, likely a phlgemon, at L2, and a 3.5 × 4.4 cm abscess in the left psoas muscle from L1 to L3. MRI of the lumbar spine also showed an additional focus of infection at T12. Cultures obtained from the left psoas abscess revealed growth of Brucella melitensis. Otherwise, no evidence of malignancy or tuberculosis was discovered after an extensive evaluation. After drainage of the left psoas abscess, she underwent decompressive laminectomy at L1. She had been started on intravenous piperacillin/tazobactam and vancomycin, which was changed to oral doxycycline and intravenous gentamicin after the diagnosis of brucellar spondylodiscitis. Gentamicin was discontinued after she developed acute kidney injury and replaced with oral rifampin. On subsequent hospital admissions she underwent posterolateral fusion at T11, T12, L3, and L4 and anterior L1, L2 corpectomies, with placement of mechanical interbody cage from T12 to L3.

CT of lumbar spine.

Discussion:

Brucella is a common cause of osteomyelitis, spondylodiscitis, and associated paravertebral, epidural, or psoas abscesses in endemic areas. Approximately 100–200 cases are reported in the United States each year, but it is more common in areas bordering Mexico. B. melitensis is the most common cause of human disease and is transmitted from animals to human by direct contact with infected animals or their secretions, inhalation of aerosols, and ingestion of unpasteurized dairy products. Current CDC recommendations for first‐line treatment are doxycycline and rifampin for at least 6 weeks.

MRI of lumbar spine.

Conclusions:

Brucella is an uncommon cause of spondylodiscitis in the United States but should be considered in individuals residing intermittently in Mexico. Treatment with doxycycline and rifampin, in conjunction with appropriate surgical management, is associated with a favorable prognosis.

Disclosures:

W. W. Chang ‐ none; J. C. Lin ‐ none

To cite this abstract:

Chang W, Lin J. Case Report: Brucellar Spondylodiscitis and Psoas Abscess. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 248. Journal of Hospital Medicine. 2011; 6 (suppl 2). https://www.shmabstracts.com/abstract/case-report-brucellar-spondylodiscitis-and-psoas-abscess/. Accessed July 23, 2019.

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