Title : Brucellosis presenting as chronic back pain
Abstract:
A 43-year-old male was seen in the clinic for a slowly progressive low back pain over the last 3 months. This was associated with an unintentional weight loss of 11 lbs. During this period, he had an extensive workup of his back pain including an initial computed tomography of his thoracolumbar spine which revealed a disc bulge at L5-S1. Conservative management had been advised at that time but due to progressive symptoms over the next month, a magnetic resonance imaging (MRI) scan was pursued that revealed an abnormal signal enhancement in T6- T8 along with degenerative changes at L4-L5 and L5-S1. These were again thought to be secondary to degenerative disc disease as the patient had no other systemic symptoms.
Patient continued to have progressive symptoms which made it difficult for him to perform activities of daily living. Therefore, another follow up MRI was performed prior to clinic visit and it revealed changes consistent with discitis and osteomyelitis at T6-T8, L4-L5 and L5-S1 along with a small lumbar epidural abscess. Patient was then hospitalized for further evaluation. He underwent aspiration of epidural fluid for various cultures. Blood cultures were also performed along with other non-invasive tests like Q fever and Brucella serologies as well as QuantiFERON-TB Gold+ assay. Cultures of blood and abscess fluid subsequently grew Brucella abortus. Patient did recall consuming milk bought directly from a local farm.
This case illustrates a classic presentation of Brucella spondylitis resulting from consuming unpasteurized milk. It also highlights the challenges associated with diagnosis including the current rarity of the disease, lack of systemic symptoms, leukocytosis, elevated inflammatory markers and early imaging changes which are typically associated with more commonly seen acute cases of infectious spondylitis. Finally, it also highlights the importance of pasteurizing milk and other dairy products to prevent food borne illnesses.
The current social trend of consuming a more ‘natural’ diet and obtaining food ‘directly from the source’ can lead to re-emergence of previously common diseases that are not seen in contemporary medical practice due to improvements in food hygiene practices.
