Spinal brucellosis causing spondylodiscitis

INTRODUCTION: 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. CASE PRESENTATION: 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). CLINICAL DISCUSSION: 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. CONCLUSIONS: 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.