Ziegenkäse und Spondylodiszitis

Brucellosis is a widespread zoonosis, especially in the Mediterranean region, and is transmitted by close contact with animals or by consumption of milk and dairy products. We report a 58-year-old Turkish patient living in Austria who was referred for clarification of back pain of 7 weeks duration that was particularly pronounced at night. An MRI scan taken as outpatient demonstrated pronounced spondylodiscitis at TH8/9 and TH 10 / 11. The case history revealed that the patient suffered not only from undulating episodes of fever but also profuse sweating and chronic fatigue. Furthermore, there was a weight loss of 5 kg in the past 7 weeks and the patient was being treated with 2 antidepressants for depressive symptoms. After specific questioning we found that, although the patient had last been in a rural area in Turkey six months previously, in Austria he almost continuously consumed home-made sheep and goat cheese brought from Turkey by relatives. Laboratory tests revealed pronounced signs of inflammation. On the basis of the typical clinical signs and a positive blood culture of Brucella melitensis, we diagnosed brucellosis and initiated an antibiotic combination therapy: rifampicin for 8 weeks and doxycyclin for 6 months. Under this therapy, the complaints improved and the signs of inflammation declined continuously so that the patient was free of symptoms after 4 weeks. Our case impressively documents that even in Central Europe and especially among immigrants from the Mediterranean region, brucellosis should be considered in the differential diagnosis of spondylodiscitis, also when the travelling history presumably excludes an acute infection.