Starakis Ioannis, Solomou Katerina, Konstantinou Dimitrios, Karatza Chrysoyla
Department of Internal Medicine, Patras University Hospital, 26500 Rion, Patras, Greece.
Cases J. 2009 Jul 2;2:7614. doi: 10.4076/1757-1626-2-7614.
Brucellar epidural abscess is rare but potentially fatal medical entity and very few cases have been reported so far. Whilst in developed countries, cases of brucellar spondylitis and epidural abscess are unusual, since brucellosis has practically been eradicated in animals, in Greece it is one of the most frequent zoonosis. By reporting this case report we want to stress out the importance of early diagnosis and management and also that physicians should keep an open mind and high index of suspicion especially in regions where brucellosis is endemic or when their patients have traveled to these areas and have consumed unpasteurized dairy products.
We present the case of a 41-year-old male Caucasian farmer complaining of acute, progressively worsening low back pain of five days duration. Fever with rigors, malaise and profuse night sweating were added to the symptoms, two days before admission. Magnetic Resonance imaging clearly showed the lesion and blood and tissue cultures were positive for Brucella melitensis.
Spinal epidural abscess is a rare condition, difficult to diagnose, may be complicated by potentially disastrous neurological or vascular complications, and it can be fatal if left untreated. Patients complaining of fever and back pain, particularly in endemic areas should be investigated as possible cases of brucellosis and MRI is the method of first choice in the diagnostic process. Neurological dysfunction is often disproportionate to the observed degree of compression. A delay in diagnosis or surgical treatment may result in deleterious sequelae such as permanent paralysis or even death for patients with spinal epidural abscess.
布鲁氏菌性硬膜外脓肿是一种罕见但可能致命的医学病症，迄今为止报道的病例很少。在发达国家，布鲁氏菌性脊柱炎和硬膜外脓肿病例并不常见，因为动物布鲁氏菌病实际上已被根除，但在希腊，它是最常见的人畜共患病之一。通过报告本病例，我们想强调早期诊断和治疗的重要性，同时医生应保持开放的思维和高度的怀疑指数，特别是在布鲁氏菌病流行的地区，或者当患者前往这些地区并食用了未经巴氏消毒的乳制品时。
我们报告一例41岁的男性白种农民，主诉持续5天的急性、进行性加重的下背部疼痛。入院前两天，症状中增加了寒战、不适和大量盗汗。磁共振成像清楚地显示了病变，血液和组织培养物中布鲁氏菌呈阳性。
脊柱硬膜外脓肿是一种罕见的病症，难以诊断，可能会并发潜在的灾难性神经或血管并发症，如果不治疗可能会致命。主诉发热和背痛的患者，特别是在流行地区，应作为布鲁氏菌病的可能病例进行检查，磁共振成像（MRI）是诊断过程中的首选方法。神经功能障碍往往与观察到的压迫程度不成比例。脊柱硬膜外脓肿患者诊断或手术治疗的延迟可能会导致有害的后遗症，如永久性瘫痪甚至死亡。
