Background:Osteoarticular involvement is one of the most common complications of brucellosis and it can occur in up to two thirds of patients infected. Vertebral involvement during brucellosis is considered not only as the most prevalent localization but also as the most severe one.Objectives:The aim of the present study was to describe the clinical and the magnetic resonance imaging features of brucellar spondylodiscitis.Methods:We conducted a retrospective study including 21 patients who have been hospitalized for spinal brucellosis from 1998 to 2019. The diagnosis of brucellosis was based on clinical symptoms, MRI findings and isolation of brucella species in blood or tissue specimens and/or a positive Wright agglutination test.Results:Twenty-one patients were included. The mean age was 57.5 years [33-74] (13 males and 8 female). The geographical origin of the patients was rural in 76% of the cases. The median duration of symptoms progression before diagnosis was 4.5 months [1-8].The main symptom leading to seek medical care was an inflammatory back pain and it was found in all cases. It was associated with unilateral radiculopathy in 8 cases and with a bilateral radiculopathy in 1 case. The other clinical features found were fever in 17 patients, sweats in 14 cases, weight loss in 10 cases and hepatomegaly in 1 patient. The physical examination revealed tenderness on palpation in 12 cases, a motor weakness of the two lower limbs in 2 cases. Brucella agglutination test was ≥1/160 in all cases. Blood cultures were negative in all cases. The median erythrocyte sedimentation rate (ESR) and serum C-reactive protein level were 40 mm and 11mg/dl) respectively. Spondylodiscitis was located in the lumbar dorsal and cervical spine in respectively 10, 8 and 3 cases. The most affected level was the L4-L5 level in 5 cases followed by the T10-T11 level in 3 cases. The involvement of more than 2 vertebrae was found in 4 cases. Associated sacroiliitis was found in one patient. All MRI images of the affected vertebrae showed hypo intense signal on T1 weighted image and hyper intense signal on T2 weighted image. Disc space narrowing was found in 8 cases. Vertebral body osteolysis was found in 10 cases. Epidural collection was documented in 3 cases with a size up to 5cm. Paravertebral and peri-vertebral abscesses were detected in 5 cases. Intradiscal abscesses were observed in 3 cases. Cord compression and involvement of root nerve were noted in respectively 5 and 1 cases. Biopsy was performed in 5 cases, but bacteriological examination was contributory to the diagnosis in 1 case. All patients received antibiotic treatment with a combination of two or three drugs, corticosteroids were prescribed in 5 patients and one patient underwent a surgical intervention. The evolution was good 16 in patients, three patients suffered from chronic back pain, one patient had persistent neuropathic pain and one patient had paresis.Conclusion:Brucella spondylodicitis is still a serious public health problem in developing countries. MRI findings associated with clinical symptoms may establish the diagnosis even if bacteriological examinations are negativesDisclosure of Interests:None declared.
Sinusoidal obstruction syndrome: A systematic review of etiologies, clinical symptoms, and magnetic resonance imaging features
