Lumbar spinal brucellosis presenting as an atypical epidural abscess.

Authors

Faisal Alzahrani, Fahad Albadr, Fawaz S Almotairi, Khalid Almasar, Reem Alanazi, Mohammed Alhaqbani

Published in

BMJ case reports. Volume 19. Issue 9. Sep 29, 2026. Epub Sep 29, 2026.

Abstract

Brucellosis is a zoonotic infection that affects the spine, typically presenting as spondylodiscitis. Predominantly, epidural involvement without significant concurrent disc or vertebral involvement is rare and may closely mimic non-infectious pathologies. We report a man in his 50s presenting with low back pain and lower limb radiculopathy. Initial MRI demonstrated an epidural-predominant ventral epidural collection at L4-L5 associated with a posterior annular fissure, without significant vertebral or disc involvement, mimicking a sequestered disc fragment. Diffusion-weighted imaging showed peripheral restriction, and post-contrast imaging demonstrated thick rim enhancement, favouring infection. Follow-up MRI at 10 days revealed new vertebral marrow oedema consistent with evolving spondylodiscitis. Blood cultures confirmed Brucella species. Despite antibiotic therapy, progressive neurological and radiological deterioration necessitated surgical decompression. Histopathology confirmed an infected epidural collection. This case illustrates a rare epidural-first presentation of spinal brucellosis and highlights MRI discriminators and the role of short-interval follow-up imaging in diagnostically challenging epidural lesions.

PMID:
42810754
Bibliographic data and abstract were imported from PubMed on 30 Sep 2026.

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