A case of brucellar spondylitis with lumbar spondylolisthesis

Abstract

A 46-year-old man was hospitalized with a 6-month history of severe low back pain in addition to weight loss, fatigue, and intermittent febrile symptoms for the past 4 weeks. Physical examination revealed painful and restricted low back movement. His temperature was 37.5℃. Laboratory values were as follows: white blood cell count: 9,600/mm 3 , hemoglobin: 13.5g/dl, erythrocyte sedimentation rate: 45mm/h, and C-reactive protein: 58mg/L. The Rose-Bengal test was (++), and the Brucella agglutination test was positive with a titer of 1:320. Computed FIGURE A -CT revealed intervertebral destruction and narrowing at L4-5, and I° lumbar spondylolisthesis with posterior displacement (arrow in FIGURE A-a). There was marginal damage of the centrum as well as hyperostosis osteosclerosis. The margin of the centrum showed lace-like changes (arrow in FIGURE A-b). MRI revealed L4-5 intervertebral disc tissues, and the L4-5 vertebral bodies were hypointense, heterogeneous, and heterogeneous on T1WI, T2WI and STIR images, respectively (arrow in FIGURE A-c). CT: computed tomography; MRI: magnetic resonance imaging; T1WI: T1 weighted imaging; T2WI: T2 weighted imaging; STIR: Short time inversion recovery. tomography (CT) revealed intervertebral destruction and narrowing at L4-5 and I° l umbar spondylolisthesis with posterior displacement (1) . There was i sthmic spondylolisthesis, and there was marginal damage of the centrum as well as hyperostosis osteosclerosis. The margin of the centrum showed lace-like changes ( Figure A and Figure B). Magnetic resonance imaging (MRI) showed signs compatible with osteomyelitis of the L4 and L5 vertebral bodies with accompanying discitis. L4-5 intervertebral disc tissues were hypointense, heterogeneous, 875Zhang Q et al. -Brucellar lumbar spondylolisthesis and heterogeneous on T1 weighted imaging (T1WI), T2 weighted imaging (T2WI), and S hort time inversion recovery (STIR) MRI images, respectively ( Figure A and Figure C). Antimicrobial therapy was continued for 6 weeks. Surgical intervention was planned for excision of the lesion and reduction of the spondylolisthesis (2),(3) . Histopathological examination revealed tissular and cellular hyperplasia, a proliferating nodule, and granuloma in the focus. Giemsa staining showed positive Brucella (Figure B). On the control X-ray after surgery, the intervertebral height had been restored, and the lumbar spondylolisthesis was reduced ( Figure C).