E039 Radiological features of brucellar spondylodiscitis

Abstract Background/Aims Osteoarticular involvement is the most common manifestation of focal brucellosis. Spinal involvement represents the most severe form. Our objective was to describe the radiological presentation of brucellar spondylodiscitis. Methods We retrospectively collected data from 12 patients diagnosed with brucellar spondylodiscitis in a rheumatology department over 7 years [2016-2023]. The diagnosis of brucellosis was established based on clinical findings, magnetic resonance imaging (MRI) findings, identification of Brucella species in blood cultures or disco-vertebral biopsy, and/or positive Wright serology. Results Among 80 Patients with spondylodiscitis, brucella was diagnosed in 12 cases (15%). There were 6 women and 6 men with a median age of 59,75±13,97 years. Six patients reported the consumption of unpasteurized dairy products. The mean duration of symptom evolution was 2.85 ± 1.65 months. Patients predominantly complained of inflammatory back pain (83%), fever (83%), and profuse night sweats (42%). The spondylodiscitis affected the lumbar, dorsal, and cervical regions in 2, 4, and 4 patients, respectively. Two patients had multifocal involvement: 1 in the cervico-lumbar region and 1 in the dorso-lumbar region. Shoulder involvement was seen in another patient. Wright’s test was positive in 10 patients. Plain radiographs revealed disc space narrowing (n = 9, 75%), vertebral endplate irregularities (n = 7, 58%), erosions (n = 5, 41%), and vertebral collapse (n = 3, 25%). Bone spurs were seen in 2 patients (17%). Computed tomography (CT) scans performed in 10 patients showed disc space narrowing in 80%, erosions of adjacent endplates in 40%, and paravertebral soft tissue abscesses in 40%. MRI performed in 10 cases revealed abnormal signal intensity of the disc and adjacent endplates in all patients, erosions in 3, intracanalicular abscess in 5, paravertebral abscess in 5, epidural collection in 5 and spinal cord compression in 4. Conclusion Brucellar spondylodiscitis represented 18% of infectious spondylodiscitis. The most affected regions in our series were cervical and dorsal regions contrasting with literature findings. The discretion of vertebral destruction and late constructive signs can provide clues for diagnosis. A comprehensive assessment of the complete clinical context, combined with laboratory findings, contributes significantly to establishing the diagnosis. Disclosure M. Dhifallah: None. M. Slouma: None. R. Battikh: None. I. Gharsallah: None.