Ali Adam Abdirahim, Sheikh Hassan Mohamed, Adam Osman Ahmed
Department of Infectious Diseases, Mogadishu Somali Turkish Training and Research Hospital, Somalia.
Department of Neurology, Mogadishu Somali Turkish Training and Research Hospital, Somalia.
Ann Med Surg (Lond). 2022 Sep 23;82:104782. doi: 10.1016/j.amsu.2022.104782. eCollection 2022 Oct.
and Importance: Brucellosis is a common prevalent zoonotic disease in developing countries including Somalia. Brucellosis may affect many organs. However involvement in the spine and paravertebral muscles is common and may lead to diagnostic challenges since it presents with non-specific symptoms.
Here we report 18-year old male patient who presented with low back pain, low grade fever, difficult voiding and progressive lower extremity weakness for 5 months. The pain was localized to the lumbar vertebra (tender on palpation) and radiating to both lower limbs. There was slight weakness on the left lower limb (muscle power 3+/5). There were no associated sensory symptoms or deep tendon reflex abnormality. But he had mild urine retention.Lumbar magnetic resonance imaging (MRI) revealed spondylodiscitis. Rose-Bengal test was positive for brucellosis. A Brucella standard tube agglutination test was positive at a titer of 1:64. Given the test results and the imaging finding, the patient was diagnosed with Spinal brucellosis. He was treated with oral doxycycline (100 mg, two times daily) and Rifampicin (600Mg) orally once daily for 6 months. Streptomycin was added during the first three weeks. The patient had massive improvement after 3 months of treatment, (the patient's symptoms almost disappeared).
Spinal brucellosis is characterized by the involvement of the vertebral column, interspinal spaces, and/or paraspinal areas. Its subacute or chronic forms typically affect the spinal column. Spinal brucellosis may cause Spondylitis, spondylodiscitis or epidural abscess causing spinal compression. This case presented with spondylodiscitis and was successfully treated without the need for surgical intervention.
Brucella spondylodiscitis, though uncommon and challenging, it should be kept in mind in the differential diagnosis of patients presenting with chronic back pain and lower extremity weakness living in endemic areas like Somalia. The duration of treatments should be prolonged in patients with worse physical condition.
及其重要性：布鲁氏菌病是包括索马里在内的发展中国家常见的人畜共患病。布鲁氏菌病可能影响多个器官。然而，脊柱和椎旁肌肉受累很常见，且由于其表现为非特异性症状，可能导致诊断困难。
我们在此报告一名18岁男性患者，他出现下背部疼痛、低热、排尿困难和进行性下肢无力5个月。疼痛局限于腰椎（触诊时有压痛）并放射至双下肢。左下肢有轻微无力（肌力3+/5）。无相关感觉症状或深腱反射异常。但他有轻度尿潴留。腰椎磁共振成像（MRI）显示脊椎间盘炎。虎红试验布鲁氏菌病呈阳性。布鲁氏菌标准试管凝集试验滴度为1:64时呈阳性。根据检查结果和影像学发现，该患者被诊断为脊柱布鲁氏菌病。他接受了口服强力霉素（100毫克，每日两次）和利福平（600毫克），每日一次口服，持续6个月的治疗。在前三周加用链霉素。治疗3个月后患者有显著改善，（患者症状几乎消失）。
脊柱布鲁氏菌病的特征是脊柱、椎间间隙和/或椎旁区域受累。其亚急性或慢性形式通常影响脊柱。脊柱布鲁氏菌病可能导致脊柱炎、脊椎间盘炎或硬膜外脓肿，从而引起脊髓压迫。本病例表现为脊椎间盘炎，未经手术干预即成功治愈。
布鲁氏菌性脊椎间盘炎虽然不常见且具有挑战性，但对于生活在索马里等流行地区、出现慢性背痛和下肢无力的患者进行鉴别诊断时应予以考虑。身体状况较差的患者治疗时间应延长。
