Periacetabular Brucella Osteomyelitis

Hakan Cift¹, Krishna Reddy², Esat Uygur³, Salih Söylemez³, Serkan Şenol⁴, Korhan Ozkan³, Maria Silvia Spinelli⁵, Abdullah Eren⁶

¹Orthopaedics and Traumatology Department, Medipol University, Istanbul, Turkey.
²Orthopaedics and Traumatology Department, Royal Orthopaedic Hospital, Birmingham, United Kingdom.
³Orthopaedics and Traumatology Department, Medeniyet University Goztepe Research and Training Hospital, Istanbul, Turkey.
⁴Department of Pathology, Medeniyet University Goztepe Research and Training Hospital, Istanbul, Turkey.
⁵Orthopaedics and Traumatology Department, University Hospital Agostino Gemelli, Catholic University of the Sacred Heart School of Medicine, Rome, Italy.
⁶Orthopaedics and Traumatology Department, Florence Nightingale Hospital, Istanbul, Turkey..

DOI: 10.4236/ojo.2013.31005                

Abstract

Introduction: Although Brucellosis has a limited geographic distribution; it remains a challenge in certain parts of the world such as in Mediterranean, western Asian, Latin American and African regions. We present a unique case of periacetabular Brucella osteomyelitis and increase awareness of possible widespread distrubition of Brucella osteomyelitis and its ability to affect any region of the musculoskeletal system. Case Presentation: A 44-year-old male farmer presented with symptoms of pain radiating from his left hip to his thigh of five years duration. There was a history of night sweats and fever for the past two months. A lytic area with smooth borders in left periacetabular region was detected on pelvic roentgenography of the patient. Magnetic resonance imaging revealed a cavitatory lesion in relation to hip joint. Open biopsy was undertaken with the differential diagnosis of an infectious (Brucella or Tuberculous) or tumoral lesion. Intraoperative frozen sections showed granulomatous inflammatory tissue. Post debridement, the cavity was filled with autograft taken from the patient’s right iliac wing. Postoperative immunohistochemistry confirmed diagnosis of Brucella osteomyelitis. Oral Doxycyline, Rifampicine and Ciprofloxacin were administered for 3 months. At one-year postoperatively, the patient had a painless, unrestricted range of motion and function in relation to the affected hip. Conclusion: In endemic regions, Brucella osteomyelitis should be considered in differential diagnosis in patients with arthralgia and/or spondylodiscitis in the presence of radiologically suspected osseous lesions.

Keywords

Brucella; Acetabulum; Osteomyelitis

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	G. L. Mandell, “Principles and Practice of Infectious Diseases,” 5th Edition, Philadephia, 2000, pp. 2386-2393.
[2]	W. J. Koopman, “Arthritis and Allied Conditions,” 14th Edition, Philadelphia, 2001, p. 2576.
[3]	A. R. Mousa, S. A. Muhtaseb, D. S. Almudallal, S. M. Khodeir and A. A. Marafie, “Osteoarticular Complications of Brucellosis: A Study of 169 Cases,” Reviews of Infectious Diseases, Vol. 9, No. 3, 1987, pp. 531-543. doi:10.1093/clinids/9.3.531
[4]	Y. Weil, Y. Mattan, M. Liebergall and G. Rahav, “Brucella Prosthetic Joint Infection: A Report of 3 Cases and a Review of the Literature,” Clinical Infectious Diseases, Vol. 36, No. 7, 2003, pp. 81-86. doi:10.1086/368084
[5]	S. G. Gundes, H. Gundes, A. Sarlak and A. Willke, “Primary Brucellar Psoas Abscess: Presentation of a Rare Case of Psoas Abscess Caused by Brucella melitensis without any Osteoarticular Involvement,” International Journal of Clinical Practice, Vol. 147, 2005, pp. 67-68.
[6]	L. Cecchini, G. Coari, A. Iagnocco and G. Valesini, “Brucellar Spinal Abscess: Case Report,” Reumatismo, Vol. 53, No. 3, 2001, pp. 229-231.
[7]	T. P. Fowler, J. Keener and J. A. Buckwalter, “Brucella Osteomyelitis of the Proximal Tibia” The Iowa Orthopaedic Journal, Vol. 24, 2004, pp. 30-32.
[8]	N. Sayar, S. Terzi, H. Y. Yilmaz, H. Atmaca, F. Kocak, S. U. Dayi, N. Cakmak, A. Tarhan, A. Ozler and K. Yesilcimen, “A Case of Prosthetic Mitral Valve Brucella Endocarditis Complicated with Torsades de Pointes,” Heart and Vessels, Vol. 21, No. 5, 2006, pp. 331-333. doi:10.1007/s00380-006-0907-3
[9]	H. Turan, K. Serefhanoglu and E. Karadeli, “A Case of Brucellosis with Abscess of the Iliacus Muscle, Olecranon Bursitis, and Sacroilitis,” International Journal of Infectious Diseases, Vol. 13, No. 6, 2009, pp. 485-487. doi:10.1016/j.ijid.2009.02.002
[10]	Y. Tasova, N. Saltoglu, G. Sahin and H. Z. Aksu, “Osteoarticular Involvement of Brucellosis in Turkey,” Clinical Rheumatology, Vol. 18, No. 3, 1999, pp. 214-219. doi:10.1007/s100670050087
[11]	A. Pourbagher, M. A. Pourbagher, L. Savas, T. Turunc, Y. Z. Demiroglu, I. Erol and D. Yalcintas, “Epidemiologic, Clinical, and Imaging Findings in Brucellosis Patients with Osteoarticular Involvement,” American Journal of Roentgenology, Vol. 187, No. 4, 2006, pp. 873-880. doi:10.2214/AJR.05.1088
[12]	A. Zwass, F. Feldman. “Case report 875: Multifocal Osteomyelitis—A Manifestation of Chronic Brucellosis,” Skeletal Radiology, Vol. 23, No. 8, 1994, pp. 660-663. doi:10.1007/BF02580393
[13]	G. F. Araj, “Update on Laboratory Diagnosis of Human Brucelloscis,” International Journal of Antimicrobial Agents, Vol. 36, Suppl. 1, 2010, pp. 12-17. doi:10.1016/j.ijantimicag.2010.06.014