Brucellar spondylodiscitis: A case series with focus on histopathological features

Area of Science:

• Pathology
• Infectious Diseases
• Rheumatology

Background:

• Brucellar spondylodiscitis (BS) is the most frequent manifestation of musculoskeletal brucellosis.
• Definitive diagnosis relies on isolating Brucella spp., but histopathological features are not widely documented.
• BS exhibits a broad spectrum of lesions, including non-specific and granulomatous forms.

Purpose of the Study:

• To report the histopathological features of Brucellar spondylodiscitis (BS).
• To analyze the spectrum of histopathological findings in a series of BS cases.
• To evaluate the diagnostic challenges posed by non-specific BS forms.

Main Methods:

• A case series study involving 21 patients with Brucellar spondylodiscitis (BS).
• Detailed histopathological examination of tissue samples from affected vertebrae and intervertebral discs.
• Analysis of inflammatory cell predominance and granuloma formation.

Main Results:

• Ten cases (48%) showed non-specific forms, predominantly with lymphocytes, and one with neutrophils.
• Eleven cases (52%) exhibited granulomatous forms, primarily histiocytic type.
• Histiocytic granulomas were highly suggestive of BS; caseous-like necrosis was observed in one case.

Conclusions:

• The histopathological diagnosis of Brucellar spondylodiscitis (BS) is challenging due to non-specific findings in nearly half the cases.
• Histiocytic granulomas are a key indicator, while non-specific inflammatory patterns can mimic pyogenic spondylodiscitis.
• Awareness of potential features like caseous-like necrosis is important for differentiating BS from tuberculosis.