Lumbar spinal brucellosis presenting as an atypical epidural abscess.
Faisal Alzahrani, Fahad Albadr, Fawaz S Almotairi et al.
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Case in brief
A man in his 50s presented with low back pain and lower limb radiculopathy. MRI revealed a ventral epidural collection at L4-L5, resembling a sequestered disc fragment, without significant vertebral or disc involvement. Blood cultures confirmed Brucella species. Despite antibiotic treatment, he experienced neurological deterioration, leading to surgical decompression, which confirmed an infected epidural collection.
What made this case unusual
The case highlights an atypical presentation of brucellosis as an epidural abscess without significant spondylodiscitis, which is rare and can mimic non-infectious conditions.
Diagnostic / clinical pearl
Clinicians should consider brucellosis in cases of epidural abscess with atypical MRI findings, especially when there is no significant disc or vertebral involvement.
Why it matters
This case underscores the importance of follow-up imaging in diagnosing challenging epidural lesions and the need for awareness of rare presentations of brucellosis.