Accelerated Development of Brucellar Spondylitis after Self-Modification of Treatment

By Bo Liu¹, Wendong Xie², Zhiqi Zhang³

Affiliations

1. Department of Orthopaedics, Gansu Provincial Hospital, Lanzhou, Gansu, China
2. Department of Orthopaedics, Gansu University of Chinese Medicine, Gansu, China
3. Department of Orthopaedics, Minle County Hospital of Traditional Chinese Medicine, Minle County, China

doi: 10.29271/jcpsp.2025.06.807

Sir,

Brucellar spondylitis is a disease caused by brucella infection, usually transmitted to humans through contact with infected animals or their products. It can lead to serious health problems, including long-term pain, fatigue, and disability.¹ Currently, antibiotics are the mainstay of treatment for brucellar spondylitis.

Commonly used antibiotics include streptomycin, rifampicin, doxycycline, methotrexate/sulfamethoxazole, ciprofloxacin, and gentamicin. The antibiotics can accelerate the progression of brucellar spondylitis by allowing brucella to regrow and multiply again when given for an insufficient length of time and an insufficient dose.² When there is no improvement in symptoms after giving dose of antibiotics for an adequate duration, surgical treatment is used.

A 38-year male was hospitalised for 12 days due to fever, low back pain, and limitation of movement. He reported that three months ago he started having pain in his lower back with fever, which was relieved by oral pain medication. Symptoms recurred, and he came to our hospital on 20^th April 2024.

Figure 1: (A) CT and MRI scans showed no bone destruction. (B) CT and MRI scans show bone destruction of lumbar 3 and 4 vertebrae and abscess formation. (C) Surgical removal of lesions. (D) A drainage tube was placed at the lesion site. (E, G) Pathological examination showed changes consistent with chronic non-specific inflammation. (H) X-ray examination showed that the internal fixation of the spine was in a good position.

Physical examination showed significant lumbar tenderness with intermittent fever. CT and MRI scans showed no bone destruction (Figure 1A). The brucella antibody test showed a positive result with a titre of 1:160. Interleukin-6 (IL-6) was 13.12 pg/ml (normal range for adults: 1.0-5.0 pg/ml). Brucella infection was diagnosed in conjunction with the clinical manifestations. Doxycycline and rifampicin were given orally regularly, and the symptoms resolved. The patient was successfully discharged from the hospital on 9^th May 2024 and was instructed to continue the oral medication for six months. From 10^th May 2024 to 2^nd June 2024, the patient autonomously reduced the dose of doxycycline and rifampicin medication by half orally for 23 days. Starting from 3^rd June 2024, the patient had a recurrence of low back pain. On 10^th June 2024, the patient came back to the hospital. IL-6 was 18.30 pg/ml, and the brucella abortus antibody test was positive with a titre of 1:320. CT and MRI scans showed bone destruction of lumbar 3 and 4 vertebrae and abscess formation (Figure 1B). The diagnosis of brucellar spondylitis was made based on the patient's symptoms and signs, combined with laboratory tests and imaging. The condition was significantly worse than the first hospitalisation. From this, it can be seen that patients' voluntary adjustment to treatment may lead to the occurrence of complications. Therefore, in subsequent medicine treatment, patients should be specifically advised to follow the doctor's advice and not reduce or stop medication. If there is any discomfort, they can actively contact the supervising doctor for a solution.

After the patient was admitted this time, lumbar 3 and 4 vertebrae were examined and lesions were removed under general anaesthesia. Intraoperatively, it was seen that lumbar 3 and 4 vertebrae were destroyed with disc destruction and pus formation. Necrotic bone tissue was removed with an ultrasonic bone knife. Pus was aspirated with a suction device, and surrounding necrotic tissue was removed with a condenser knife (Figure 1C). A drainage tube was placed at the lesion site (Figure 1D). The lesion was repeatedly flushed with iodophor solution and saline through the drainage tube.

Finally, pedicle screws were implanted to stabilise the lumbar spine.³ Pathological examination showed changes consistent with chronic non-specific inflammation (Figure 1E, G).⁴ One day after the operation, the x-ray examination showed that the internal fixation of the spine was in a good position (Figure 1H). Postoperative oral doxycycline and rifampicin were continued in adequate doses. Changes in the patient's condition were recorded.

PATIENT’S  CONSENT:
Informed  consent  was  obtained  from  the  patient.

COMPETING  INTEREST:
The  authors  declared  no  conflict  of  interest.

AUTHORS’  CONTRIBUTION:
ZZ: Drafting, revision, and editing of the manuscript.
WX: Data collection, analysis, and interpretation.
BL: Data  collection.
All authors approved the final version of the manuscript to be published.

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