Brucella infection of the thoracic vertebral arch presenting with an epidural abscess: a case report.
BACKGROUND
Although Brucella spondylitis and Brucella discitis have been frequently reported, Brucella infection of the vertebral arch is rare and has not been previously described. We present the first case of Brucella infection of the thoracic vertebral arch with epidural abscess formation and discuss the clinical key points.


METHODS
A 57-year-old man of Han nationality with a history of contact with an isolated sheep stomach 2 months previously was admitted with an undulant fever, night sweats, back pain, and weakness. Thoracic magnetic resonance imaging showed laminar destruction of T9 and an epidural abscess at the T9 to 10 level with significant cord compression. Diagnosis of Brucella infection of his vertebral arch was confirmed by a positive blood culture with growth of Brucella melitensis. Total laminectomy, abscess cleansing, and percutaneous pedicular screw fixation was performed initially, followed by antibiotic treatment with a combination of doxycycline and rifampin for 4 months. Recovery was confirmed by clinical, magnetic resonance imaging, and blood culture findings.


CONCLUSIONS
This is an unusual case of Brucella infection of the vertebral arch with epidural abscess formation. Effective antibiotic therapy of a sufficient duration and timely performance of surgical treatment are the key points in management of such cases.
Department of Orthopaedic Surgery, the First Affiliated Hospital of Guangzhou Medical University, No. 151 Yanjiang Road, Guangzhou, Guangdong, 510120, China. yzhixun@163.com.
ZhiXun
Z
Yin
Department of Orthopaedic Surgery, the First Affiliated Hospital of Guangzhou Medical University, No. 151 Yanjiang Road, Guangzhou, Guangdong, 510120, China. heerxing717@aliyun.com.
ErXing
E
He
Guangzhou Medical University, No, 195 Dongfeng Xi Road, Guangzhou, Guangdong, 510182, China. dinghongmei110@126.com.
HongMei
H
Ding
Department of Orthopaedic Surgery, the First Affiliated Hospital of Guangzhou Medical University, No. 151 Yanjiang Road, Guangzhou, Guangdong, 510120, China. chenjingchen@163.com.
JingChen
J
Chen
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017347:Brucella melitensis; D002006:Brucellosis / Q000175:diagnosis* / Q000188:drug therapy*; D015299:Discitis / Q000382:microbiology*; D004318:Doxycycline / Q000627:therapeutic use; D020802:Epidural Abscess / Q000150:complications* / Q000628:therapy; D006801:Humans; D007796:Laminectomy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012293:Rifampin / Q000627:therapeutic use; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed
D000900:Anti-Bacterial Agents; D004318:Doxycycline; D012293:Rifampin