Brucellosis or tuberculosis? A case of misdiagnosed cervical spondylodiscitis leading to ATT-induced hepatitis

Brucellosis is a zoonotic infection that can affect multiple organ systems, often presenting with non-specific symptoms such as fatigue, back pain, and low-grade fever. The musculoskeletal system is frequently involved, leading to conditions like arthritis, sacroiliitis, spondylitis, spondylodiscitis, and osteomyelitis. Among these, spondylodiscitis most commonly affects the lumbar vertebrae, followed by the thoracic vertebrae, with cervical involvement being rare. Brucellosis diagnosis is challenging due to slow, low-yield cultures and limitations of standard agglutination test (SAT) and Enzyme-linked immunosorbent assay (ELISA), which may show false negatives and cross-reactivity. Overlapping clinical and radiological features with tuberculosis often cause misdiagnosis, leading to delayed diagnosis. We present a rare case of cervical brucellar spondylodiscitis with an epidural abscess, initially misdiagnosed as tuberculosis. A middle-aged patient presented with progressive quadriparesis, prompting clinical suspicion of tubercular spondylitis. The patient started on antitubercular therapy (ATT) but subsequently developed drug-induced hepatitis. Further investigation revealed Brucella was the causative agent. Treatment was adjusted accordingly, resulting in notable clinical recovery and radiological abscess resolution. Brucellar spondylodiscitis should be considered in the differential diagnosis of infective spondylitis, especially in endemic regions. Misdiagnosis as tubercular spondylitis can result in unnecessary ATT exposure and its associated complications. Timely diagnosis with appropriate serological and microbiological investigations is crucial for initiating appropriate therapy and preventing adverse outcomes. • Brucellosis should be considered as a differential diagnosis for infective spondylodiscitis. • Brucellar spondylodiscitis is often misdiagnosed as tuberculosis. • A patient with Brucellar cervical spondylodiscitis was initially misdiagnosed with tuberculosis. • The misdiagnosis led to the development of antitubercular therapy-induced hepatitis. • Blood culture & MRI findings are crucial for diagnosing Brucellar spondylodiscitis. • This case report provides a clear differentiation between brucellar and tubercular spondylodiscitis, aiding clinicians in accurate diagnosis and appropriate management.