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  • Granulomatous infective spondylitis in a patient presenting with progressive difficulty in walking: the differential between tuberculosis and brucellosis

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Unusual presentation of more common disease/injury
Case report
Granulomatous infective spondylitis in a patient presenting with progressive difficulty in walking: the differential between tuberculosis and brucellosis
  1. Eleni Papachristodoulou1,
  2. Loukas Kakoullis1,2,
  3. Stylianos Louppides2 and
  4. George Panos3,4
  1. 1 Respiratory Medicine, University of Patras School of Medicine, Patras, Greece
  2. 2 Internal Medicine, Nicosia General Hospital, Leukosia, Cyprus
  3. 3 Internal Medicine, Section of Infectious Diseases, University General Hospital of Patras, Patras, Greece
  4. 4 Internal Medicine, University Cyprus School of Medicine, Nicosia, Cyprus
  1. Correspondence to Professor George Panos; george.panos.frcp{at}gmail.com

Abstract

We report a case of infectious spondylitis in a 52-year-old woman who presented with progressive difficulty in walking. The patient had a 2-month long history of neurological symptoms, which progressed rapidly to paraplegia, following her admission. Imaging studies demonstrated the presence of vertebral lesions as well as additional tissue with inflammatory elements in the spinal canal, which caused a mass effect. In combination with the presence of increased cells and protein in the cerebrospinal fluid (CSF), the differential was steered towards causes of infectious spondylitis, primarily tuberculosis. However, brucellosis was also considered, as it is endemic in our area. Prompt surgical decompression produced biopsy samples, which confirmed the presence of granulomatous inflammation. The patient was started on an empiric regimen covering both for tuberculosis and brucellosis, and gradually regained full mobility in her lower limbs. The differential of infectious spondylitis is discussed, with an emphasis on the differentiation between tuberculosis and brucellosis.

  • bone and joint infections
  • drugs: infectious diseases
  • TB and other respiratory infections
  • spinal cord

http://dx.doi.org/10.1136/bcr-2019-232540

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    Footnotes

    • Contributors EP evaluated the patient, conducted the appropriate literature review and drafted the manuscript. LK evaluated the patient, contributed to the drafting of the manuscript and obtained informed consent from the patient. SL evaluated the patient and contributed to the drafting of the manuscript. GP was the attending physician of the patient, guided the rest of the team in the drafting of the manuscript and reviewed the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.