ab224016

Lumbar pain in a married couple who likes cheese: Brucella strikes again !

G. Taliani, A. Bartoloni, A. Tozzi, F. Bartalesi, G. Corti, F. Paradisi

Infectious Diseases Unit, Department of Critical Medicine and Surgery, University of Florence, Italy.

ABSTRACT
A 69-year-old man living in Florence reported fever and acute lumbar pain one month after transurethral resection of a superficial transitional cell carcinoma of the bladder. The radionuclide bone scan suggested metastatic lesions of the L3-L4 vertebrae. However, cobalt treatment was ineffective. A bone biopsy of L4 showed an inflammatory pattern and antibiotic therapy was started which did not produce any clinical improvement. Six months after the onset of the back pain brucellar spondylitis was serologically diagnosed and treatment with doxycycline and streptomycin produced a significant clinical and radiological improvement.
After 2 months the patient's wife presented with fever and lumbar pain, and brucellar spondylitis was diagnosed as well. An extensive epidemiological examination revealed that 8 months earlier the family had eaten unpasteurized goat cheese and serological examination of the entire family showed that 3 out of 4 members had significant titres of brucellar antibodies. Finally it was discovered that 4 months after consuming the cheese the third infected subject experienced an episode of epidydimo-orchitis for which no diagnosis and effective treatment was found.
This family cluster of brucellar infection indicates that a high degree of suspicion in the diagnosis of brucellosis is necessary even in non-endemic areas, to reduce the delay in the diagnosis and treatment of the disease and to prevent the occurrence of complications that may prove difficult to treat.

Key words
Family cluster, brucellosis, lumbar pain, radionuclide bone scan, brucellar spondylitis, unpasteurized cheese, delay in diagnosis.

Please address correspondence and reprints requests to: Gloria Taliani, MD, Infectious Diseases Unit, Department of Critical Medicine and Surgery, University of Florence, Ospedale Careggi, Viale G.B. Morgagni 85, 50134 Florence, Italy.
E-mail gloria.taliani@unifi.it\