关键词: 布鲁杆菌病, 结核, 脊柱, 误诊

Abstract:

Objective: To analyze the patients with Brucella spondylitis misdiagnosed as lumbar tuberculosis and explore the treatment outcome of Brucella spondylitis. Methods: The clinical data of Brucella spondylitis patients misdiagnosed as lumbar tuberculosis from Shaanxi Tuberculosis Control Hospital between June 2018 and June 2021 were collected, and the clinical symptoms, laboratory examination results, imaging findings, treatment methods and follow-up results were analyzed. Results: Among the 6 patients, 4 were male and 2 were female, with the mean age of (63.00±10.15) years (ranged from 54 to 81 years); 2 had contact history of Brucella, 3 had contact history of pastoral area and cattle and sheep, 1 had unknown contact history; 1 complicated with old pulmonary tuberculosis, and 1 with epidural abscess and underwent surgery. The course of disease ranged from 20 days to 1 year, with an average of (4.17±1.32) months. The duration of misdiagnosis was 7-24 days, with an average of (15.66±5.53) days. The lesion sites were as follows: 2 cases of lumbar 2-3, 1 case of lumbar 3-4, 2 cases of lumbar 4-5, and 1 case of lumbar 5-sacral 1 complicated with epidural abscess. As to imaging findings, all the 6 patients showed intervertebral space stenosis, marginal bone destruction of the vertebral body, which appeared alternately with hyperplasia and sclerosis, and the formation of adjacent intervertebral bone bridges. One case had high fever of >39℃, and the type was undulating fever, while the other 5 cases had normal body temperature. Tuberculin purified protein derivative (PPD) skin test was weakly positive in 2 cases, and generally positive in 3 cases; tuberculosis antibody was positive in 3 cases, LAM antibody and T-SPOT. TB test were positive in 2 cases. All the patients were diagnosed as Brucellosis spondylitis through the positive preliminary screening of Rose-Bengal plate agglutination test and tube agglutination test. They were treated with doxycycline hydrochloride and rifampicin for 12 weeks and followed up for 6 months. Finally, 4 patients were cured and 2 patients improved without recurrence. Conclusion: Brucella spondylitis usually has a history of disease exposure, which can be confirmed by fever type and laboratory examination. The overall prognosis of most Brucella spondylitis patients is good.

Key words: Brucellosis, Tuberculosis, spinal, Diagnostic errors