Spinal Brucellosis Without Apparent Risk Factors: A Case-Based Diagnostic Approach and Literature Review

Brucellosis is a zoonotic infection often linked to direct or indirect exposure to animals or unpasteurized dairy products. Atypical presentations in patients without classical risk factors pose significant diagnostic and management challenges. A 68-year-old woman presented with a 2-month history of burning pain involving cervical and lumbar regions, associated with weight loss, decreased appetite, and subjective fever. Examination revealed paravertebral tenderness and left knee swelling with effusion. Previous MRI showed multifocal marrow edema and soft tissue thickening in the lumbar spine, suggesting infection or inflammation. The patient denies exposure to unpasteurized dairy products, raw meat, or animals. Brucella serology revealed positive IgG with Brucella melitensis titer 1:160, later confirmed by blood cultures. PET imaging demonstrated multifocal metabolically active arthritic changes involving the spine, shoulders, and knees. Arthrocentesis confirmed inflammatory arthritis due to brucellosis. The patient was started on doxycycline, rifampin, and a 14-day course of intravenous gentamicin. During hospitalization, management was complicated by persistent knee pain and swelling requiring multimodal analgesia. Spinal brucellosis in the absence of classical risk factors is an odd presentation, emphasizing the importance of maintaining a high index of suspicion in endemic regions. Advanced imaging and microbiological confirmation are pivotal procedures in diagnosis. Early recognition of atypical brucellosis is critical to prevent complications and improve outcomes.