Brucellar Spondylodiscitis remains a significant diagnostic challenge for clinicians worldwide, particularly when it presents as a late-stage reactivation. Recently, a case report detailed a 35-year-old female patient from Syria, residing in Brazil, who developed chronic back pain. Remarkably, she had a history of brucellosis that was diagnosed and treated twenty years earlier. This case emphasizes the need for high clinical suspicion in patients with an epidemiological history, even decades after the primary event.

The patient presented with chronic back pain, headache, and discomfort in her left upper limb. Notably, she did not experience fever or weight loss, which frequently leads clinicians to overlook infectious etiologies. Magnetic resonance imaging (MRI) revealed a pathological fracture of the T8 vertebral body. Initially, histopathological examination showed a chronic granulomatous inflammatory process with necrosis. Because these findings often overlap with other diseases, the medical team first treated the condition as bone tuberculosis. However, subsequent laboratory confirmation finally identified Brucella as the causative agent. Consequently, the team shifted the therapeutic approach to target brucellosis specifically.

Effective Management of Brucellar Spondylodiscitis

The treatment of spinal brucellosis requires a multi-drug regimen to ensure complete eradication and prevent further relapses. For this specific case, the patient received a combination of amikacin, rifampicin, and doxycycline for nine months. This prolonged duration is often necessary for bone-involved infections. Similarly, various studies suggest that triple-antibiotic therapy provides better outcomes compared to dual therapy in complicated presentations. Monitoring clinical improvement and radiological resolution is essential during the follow-up period. Furthermore, clinicians must distinguish this condition from spinal tuberculosis, as the pharmaceutical choices and treatment timelines differ considerably. Successful recovery in this patient was eventually confirmed through clinical and laboratory improvement.

Frequently Asked Questions

Can brucellosis reappear 20 years after the initial treatment?

Yes, brucellosis can remain latent in the body and manifest as localized infections, such as spondylodiscitis, many years later. This often occurs due to the pathogen's ability to survive within the reticuloendothelial system.

How does Brucellar Spondylodiscitis differ from spinal tuberculosis on MRI?

While both cause vertebral destruction, brucellosis typically shows more focal bone destruction and limited paravertebral involvement. Conversely, tuberculosis often presents with larger psoas abscesses and more extensive multi-level vertebral damage.

What is the recommended antibiotic duration for spinal brucellosis?

Most guidelines recommend a minimum of 12 weeks of combination therapy, though complicated cases like spondylodiscitis often require 6 to 12 months of treatment to ensure full resolution.

Disclaimer: This content is for informational and educational purposes only. It does not constitute medical advice or replace professional consultation. Refer to the latest local and national guidelines for clinical practice.

References

Kanebley M et al. Brucellar Spondylodiscitis 20 Years Post Infection. Am J Trop Med Hyg. 2026 Feb 17. doi: undefined. PMID: 41701984.

Pappas G, Akritidis N, Bosilkovski M, Tsianos E. Brucellosis. N Engl J Med. 2005 Jun 2;352(22):2325-36. doi: 10.1056/NEJMra050570.

Ulu-Kilic A, Karakas A, Erdem H, et al. Update on treatment options for spinal brucellosis. Clin Microbiol Infect. 2014;20(2):O75-O82. doi: 10.1111/1469-0691.12351.