Isolated Cervical Spondylitis due to Brucellosis

Introduction: Brucella is a gram-negative coccobacillus which can affect humans as an accidental host and cause brucellosis; also known as “Malta fever”. Brucellosis could manifest in several ways and can attack all the organs. Musculoskeletal complaints considered the most common complication in patients. The Involvement of  the lumbar region is much more frequent than the cervical or thoracic region. This article proceeds to a case with isolated cervical brucellosis. Case Presentation: A 39-year-old Iranian woman presented to an infectious disease clinic with sub-acute neck pain, bilateral paresthesia of upper limb and occasional but profuse night sweats. Two weeks earlier she was prescribed NSAIDs by a neurologist which resulted in worsening of her symptoms. She was otherwise healthy. She mentioned a trip to India three months ago where she consumed local-unpasteurized dairy products. She had a history of recent weight loss of 3 kilograms. On neurologic examination, the neck range of motion was restricted and tenderness on the lower cervical spine was detected. Distal and proximal extremity forces were reduced bilaterally (4/5) with decreased deep tendon reflexes of biceps and sensory deficit which was more significant on the palmar aspect of fingers 1-3, consistent with C7 dermatome. blood cell count was normal, (ESR): 20 mm/h, C-reactive protein (CRP): 13 mg/L, wright: 1/1280, 2ME: 1/640. Blood cultures came back negative. Spinal MRI scan revealed an abnormal signal intensity of C4 to C6 vertebrae and a decrease in height of C5/C6 intervertebral disc suggestive of spondylodiscitis plus anterior wedging of C5 with endplate irregularity. The patient to start on outpatient treatment with Gentamicin  plus Doxycycline plus Rifampin. After 2 weeks of treatment initiation, spinal tenderness decreased significantly and the neck range of motion restored. CRP and ESR decline to normal values (2 mg/L and 5 mm/h respectively). The patient immigrated to another country and went out of reach, so follow-up imaging had not been performed, but follow-up MRI advised to be done at the end of the treatment course to evaluate regimen efficacy and probable need to treatment extension. Conclusions: It should be kept in mind that brucellosis may present with a painful and stiff neck in patients who reside in endemic regions or have traveled to those countries.