Lumbar epidural abscess caused by brucella species: report of two cases

Abstract

SummarySpinal epidural abscess due to Brucella species is usually associated with spondylodiscitis. Urgent surgical decompression should be performed in cases with moderate to severe neurological deficits particularly if progressive. We report clinical features of two cases operated for lumbar epidural abscess caused by Brucella species. Early surgical decompression combined with medical treatment could decrease progression of neurological findings or the severity of complications. Iatrogenic dural tear at the operation should be repaired immediately with fine sutures and fibrin tissue glue to prevent further innoculation into the cerebrospinal axis. These cases should be cautiously followed for any recurrence or neurobrucellosis.KEY WORDS: Epidural abscess. Brucellosis. Brucella spondylitis. Lumbar region. Surgery. Dural tear Absceso epidural lumbar causado por brucella: descripción de dos casos Resumen Los abscesos epidurales espinales debidos a Brucella se asocian habitualmente a espondilodiscitis. La descompresión quirúrgica urgente debe ser realizada en casos con déficit neurológico moderado o grave particularmente si este es progresivo. Describimos los aspectos clínicos de dos casos operados por abscesos epidurales causados por Brucella. El tratamiento quirúrgico temprano asociado con tratamiento médico puede disminuir la progresión de la sintomatología neurológica y la gravedad de las complicaciones. La aparición de desgarros durales durante la cirugía debe ser reparada de forma inmediata con sutura o pegamentos de fibrina para prevenir la inoculación dentro del neuroeje. Estos casos deben ser seguidos de forma cuidadosa para evitar la recurrencia de la neurobrucelosis.PALABRAS CLAVE: Absceso epidural. Brucelosis. Espondilitis por brucella. Región lumbar. Cirugía. Desgarro dural.

Unusual presentation of neurobrucellosis: a solitary intracranial mass lesion mimicking a cerebral tumor

“…Positive blood culture is crucial as a definitive diagnostic tool. Furthermore, the culture of surgical or biopsy specimens may reveal a localized infection caused by Brucella species, such as neurobrucellosis [3, 12]. …”

Case report on the development of a brucellosis-related epidural abscess

“…In case of Brucella-related epidural abscess, the source is most probably adjacent vertebrae. Several cases of brucellosis related epidural abscess have been reported in the literature [6,[12][13][14]. A study by İzci et al in 2005 reported that a patient who had presented with leg and sciatic pain was found to have spinal epidural abscess on MRI examination and development of Brucella melitensis in the blood culture [13].…”

Abscess of cauda equina presenting as lumboischialgic pain: a

“…Infrequently, spinal abscess may be the cause of sciatica and may demonstrate similar symptoms, thus being easily mistaken for another form of pathology [5]. Initial diagnosis may include spinal degenerative conditions, musculoskeletal injuries, malignancy and infectious agents, most often discitis or vertebral osteomyelitis as well as some of the rarer medical emergencies [2,3,5].…”

“…Tomaz Velnar, Gorazd Bunc the most common region of involvement, spinal intradural abscess may be formed anywhere along the spinal cord, most commonly involving the thoracic region [3,10,12]. Thus, a high level of suspicion must be present when managing a patient with back pain in order to avoid confusion with more common spinal problems, for example a herniated disc [2].…”