Lumbar spinal brucellosis presenting as an atypical epidural abscess

Brucellosis is a zoonotic infection that affects the spine, typically presenting as spondylodiscitis. Predominantly, epidural involvement without significant concurrent disc or vertebral involvement is rare and may closely mimic non-infectious pathologies. We report a man in his 50s presenting with low back pain and lower limb radiculopathy. Initial MRI demonstrated an epidural-predominant ventral epidural collection at L4-L5 associated with a posterior annular fissure, without significant vertebral or disc involvement, mimicking a sequestered disc fragment. Diffusion-weighted imaging showed peripheral restriction, and post-contrast imaging demonstrated thick rim enhancement, favouring infection. Follow-up MRI at 10 days revealed new vertebral marrow oedema consistent with evolving spondylodiscitis. Blood cultures confirmed Brucella species. Despite antibiotic therapy, progressive neurological and radiological deterioration necessitated surgical decompression. Histopathology confirmed an infected epidural collection. This case illustrates a rare epidural-first presentation of spinal brucellosis and highlights MRI discriminators and the role of short-interval follow-up imaging in diagnostically challenging epidural lesions.