Brucella spondylodiscitis

45 year old gentleman presented with vague low back ache. An MRI was asked for to rule out lumbar disc disease.

MRI

sagstirspine

Sagittal STIR

Findings

  • STIR hyperintense signals are seen involving the L3 and L4 vertebral bodies.
  • breach of the anterior half of superior end plate of L4 with a fluid signal intensity traversing the L3-4 disc superiorly to extend to the inferior end plate of L3.
  • anteriorly it extends subligamentous to the right of midline mildly displacing the IVC anteriorly.
  • no involvement of psoas muscles.
  • no posterior extension into epidural space.
  • no other vertebral joint involvement.
  • rest of the intervertebral discs and lumbar vertebrae are normal.

Key points

  • Imaging features are typical of spondylodiscitis.
  • This patient is of Mediterranean origin and lab investigations revealed positivity for Brucellosis.
  • Brucella spondylodiscitis has a predilection for lumbar spine and tends to present late in view of vague symptoms.

Read more

  1. Brucellosis – Radiopaedia
  2. Al-Shahed, Mona S., et al. “Imaging features of musculoskeletal brucellosis.” Radiographics 14.2 (1994): 333-348.
  3. Hong, Sung Hwan, et al. “MR Imaging Assessment of the Spine: Infection or an Imitation? 1.”Radiographics 29.2 (2009): 599-612.