Discitis, Diabetes, and Endocarditis: A Challenging Clinical Triad

A 58-year-old male farmer from southern India with a history of diabetes mellitus presented with a one-year history of fever and progressive lower back pain. He was initiated on antitubercular therapy (ATT) for suspected tuberculous spondylitis. Despite three months of ATT, his symptoms worsened, with progressive constitutional symptoms and features of heart failure. Further evaluation revealed aortic valve vegetation and persistent lumbar spondylodiscitis. Serological and imaging findings, along with occupational exposure to livestock, led to a diagnosis of brucellosis with infective endocarditis and spondylodiscitis. The patient's condition deteriorated despite supportive care and antibiotics as per treatment guidelines. This case highlights the diagnostic challenges of brucellosis in endemic regions and underscores the importance of considering zoonotic infections in patients with atypical presentations of spondylodiscitis and endocarditis, in regions where both tuberculosis and brucellosis are endemic.