Brucellosis and sacroiliitis: a common presentation of an uncommon pathogen.
Musculoskeletal problems are the most common chief complaint in ambulatory medicine across all specialties, and back pain is one of the top 10 problems encountered by the general practitioner. The differential diagnosis of lower back pain is exhaustive, but a history significant for constitutional symptoms or unusual exposures should prompt a work-up for an infectious cause. We describe the case of a 25-year-old man with a Brucella abortus sacroiliitis and possible orchiitis after consumption of unpasteurized cheese imported from El Salvador. The patient was successfully treated with gentamycin, rifampin, and doxycycline. Though the presentations of brucellosis are myriad, osteoarticular involvement of the axial skeleton is the most common presentation of this zoonotic infection. In the United States brucellosis is rarely encountered and is typically limited to people who are exposed during travel to endemic areas. Here we review briefly the epidemiology and presentation of a Brucella infection and current recommendations for treatment.
Priest
James R
JR
Stanford University School of Medicine, Stanford, CA 94305, USA. jpriest@stanford.edu
Low
Dennis
D
Wang
Cliff
C
Bush
Thomas
T
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001170:Arthritis, Infectious / Q000382:microbiology*; D002003:Brucella abortus / Q000302:isolation & purification*; D002006:Brucellosis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D002611:Cheese / Q000382:microbiology; D003937:Diagnosis, Differential; D004318:Doxycycline / Q000627:therapeutic use; D005839:Gentamicins / Q000627:therapeutic use; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D008297:Male; D009920:Orchitis / Q000382:microbiology; D012293:Rifampin / Q000627:therapeutic use; D012446:Sacroiliac Joint / Q000382:microbiology*
D000900:Anti-Bacterial Agents; D005839:Gentamicins; D004318:Doxycycline; D012293:Rifampin