Brucellar spinal epidural abscesses. Single center experience of nineteen patients and review of the literature

Brucellar spinal epidural abscesses (SEA) are rare and very few series of them have been reported. We aimed to evaluate the clinical characteristics, laboratory, radiological findings and outcome of this entity. Of 146 patients with brucellosis, 19 (13%) patients were diagnosed to have SEA during a period of 21 years (1990–2010). Diagnosis made on clinical presentation, laboratory findings, radiographic evidence and the brucellar etiology was considered when seroagglutination tests were positive at a titer of 1/160 or higher, and/or Brucella spp. were isolated in the blood. The mean age of patients was 51 ± 16 years (14 males, 5 females; age range, 22–74 years). The median diagnostic delay was 2 months. Back or neck pain (100% of patients), fever (100%), and sweating (68.6%) were the most common symptoms. Cultures of blood specimens from 4 patients (21%) were positive for Brucella melitensis. Three patients (15.8%) had motor weakness or paralysis. Magnetic resonance imaging was performed in all cases. The lumbar vertebra was the most frequently involved region with the rate of 84.2%, followed by thoracal (15.8%), cervical (5.3%), lumbosacral (5.3%), and thoraco–lumbar (5.3%) segments. A combination of rifampin and doxycycline was the most widely used therapy regimen (9 cases, 47.3%). The duration of antimicrobial therapy of brucellosis (median, 7 months; range, 4–13 months) varied according to the clinical response. There were no deaths or severe sequelae in this study. Brucellar SEA should be considered in patients who have back pain and neurologic disorders as well as systemic symptoms and findings in or from endemic areas.