A case report of cervical spine epidural abscess caused by brucellosis

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Abstract
Background: Brucellosis is an endemic zoonotic infection in Saudi Arabia, with thousands of cases reported annually. Although musculoskeletal involvement is common, spinal complications – particularly cervical spondylodiscitis with epidural abscess – are rare and often difficult to diagnose due to nonspecific symptoms. Delayed recognition may lead to neurological compromise requiring urgent intervention. Case Description: A 55-year-old farmer with regular exposure to cattle and a history of brucellosis presented with progressive right-sided weakness and neck pain. Magnetic resonance imaging revealed cervical stenosis with cord compression. Serology on admission showed Brucella immunoglobulin G positive, immunoglobulin M negative. The patient underwent anterior cervical decompression, biopsy, and fixation. Intraoperative cultures confirmed Brucella infection; however, species-level identification was not performed. Targeted antibiotic therapy with ceftriaxone 2g intravenous daily, doxycycline 100 mg orally twice daily, and rifampicin 600 mg orally daily was initiated. The patient showed gradual neurological recovery with complete resolution at follow-up. Conclusion: Spinal brucellosis, though rare, should be considered in endemic regions. Early diagnosis and combined surgical and medical management can prevent permanent neurological sequelae. The absence of Brucella species identification represents a limitation of this report.

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