Krause Cassandra, Chang Michael, Veltman Jennifer, Luo-Owen Xian, Kim Esther, Danisa Olumide, Abou-Zamzam Ahmed M, Mukherjee Kaushik
Department of Surgery, Loma Linda University, Loma Linda, CA, USA.
Department of Medicine, Loma Linda University, Loma Linda, CA, USA.
J Surg Case Rep. 2021 Feb 13;2021(2):rjaa577. doi: 10.1093/jscr/rjaa577. eCollection 2021 Feb.
Brucellosis is rare in the USA, with 100-200 cases reported annually. In this case we illustrate the complex management of spinal brucellosis. A 22-year-old male presented with 3 months of low back pain. Imaging revealed osteomyelitis/diskitis of L5/S1 and abscesses involving the pre-vertebral, epidural and pelvic recesses. Initial biopsies were inconclusive, but the patient later endorsed eating unpasteurized cheese (queso fresco) from Mexico; therefore, serology was sent and was positive. Despite aggressive antibiotic therapy there was disease progression. The patient underwent debridement of the involved vertebrae and drainage. Multiple cultures failed to grow the organisms, but polymerase chain reaction was positive. A month later he underwent a second vertebral debridement as well as placement of tobramycin impregnated beads in the vertebral space. He has since recovered. Surgery should be considered if there is a poor response to medical management and patients may need repeated debridement.
布鲁氏菌病在美国较为罕见，每年报告100 - 200例。在此病例中，我们阐述了脊柱布鲁氏菌病的复杂治疗过程。一名22岁男性出现了3个月的下背痛。影像学检查显示L5/S1椎体骨髓炎/椎间盘炎，以及涉及椎体前、硬膜外和盆腔隐窝的脓肿。最初的活检结果不明确，但患者后来承认食用了来自墨西哥的未经过巴氏杀菌的奶酪（新鲜奶酪）；因此，进行了血清学检测，结果呈阳性。尽管进行了积极的抗生素治疗，病情仍有进展。患者接受了受累椎体的清创和引流。多次培养均未培养出病原体，但聚合酶链反应呈阳性。一个月后，他接受了第二次椎体清创，并在椎间隙置入了含妥布霉素的珠子。此后他已康复。如果对药物治疗反应不佳，应考虑手术治疗，患者可能需要反复清创。
