布鲁菌性脊柱炎伴椎旁及腰大肌脓肿1例分析  

Brucella spondylitis with paraspinal and psoas muscle abscess:a case report

作　　者：宋明慧 左惠芬[2] 陈东科[3] 郑翠影 赵培 郭玉梅[4] 高伟利[4] 黄印启[1] 冯忠军[1] 叶佳情 郝佳豪 赵振军[2] 张丽杰[1] SONG Minghui;ZUO Huifen;CHEN Dongke;ZHENG Cuiying;ZHAO Pei;GUO Yumei;GAO Weili;HUANG Yinqi;FENG Zhongjun;YE Jiaqing;HAO Jiahao;ZHAO Zhenjun;ZHANG Lijie(Hebei Medical University Third Hospital,Shijiazhuang,Hebei 050051,China;Hebei Yi-Ling Hospital,Shijiazhuang,Hebei 050091,China;Department of Laboratory Medicine Beijing Hospital,Beijing 100005,China;Hebei Key Laboratory of Intractable Pathogens,Shijiazhuang Center for Disease Control and Prevention,Shijiazhuang,Hebei 050011,China)

机构地区：[1]河北医科大学第三医院,河北石家庄050051 [2]河北以岭医院,河北石家庄050091 [3]卫生部北京医院检验科,北京100005 [4]石家庄市疾病预防控制中心,河北省疑难细菌研究重点实验室,河北石家庄050011

出　　处：《中国热带医学》2024年第11期1429-1432,共4页China Tropical Medicine

基　　金：河北省自然科学基金精准医学联合基金项目(No.H2020206449);河北省疑难细菌研究重点实验室项目(No.20180460)。

摘　　要：分析2022年河北省1例腰间盘突出症患者因布鲁菌侵入血流引起布鲁菌性脊柱炎伴椎旁及腰大肌脓肿的临床与实验室特征。1例50岁男性患者,2个月前(2022年8月)劳累后出现腰部疼痛,卧床休息后症状减轻。后因腰部疼痛间断发作,查腰部CT示椎间盘膨出,期间患者多次发热。入院前12 d患者无明显诱因出现右下肢胀痛、麻木,卧床休息后症状无法缓解。于2022年10月21日入院,对患者组织和脓肿直接培养及革兰染色,行血培养、布鲁菌抗体、CT影像学检查。脓液标本革兰染色后镜检见细沙状菌体,疑似布鲁菌。椎旁脓肿标本及阳性血培养标本转种在血平板上均培养出马耳他布鲁菌。布鲁菌抗体测定阳性。腰椎椎体平扫发现腰L3-5椎体缘骨质破坏,椎旁软组织及左侧腰大肌肿胀。该患者诊断为布鲁菌性脊柱炎,其伴随的椎旁及腰大肌脓肿是一种少见的布鲁菌性脊柱炎的并发症,保守治疗效果欠佳,行手术解决神经压迫症状,同时应用抗布鲁菌病(以下简称布病)药物。15 d后患者出院,出院后继续抗布病治疗。随访1年,患者目前痊愈无复发。布病流行呈现分散多发的特点,患者临床症状不典型,易被漏诊或误诊,及时进行血培养帮助临床尽早确诊并进行有效的抗布病治疗意义重大,避免因疾病迁延导致病情加重,影响愈后。This paper analyzes a patient′s clinical and laboratory characteristics with lumbar disc herniation invaded by Brucella in the bloodstream,causing brucellar spondylitis with paravertebral and psoas abscesses in Hebei Province in 2022.A 50-year-old male patient presented with lower back pain two months after physical exertion,and the symptoms were alleviated after bed rest but recurred intermittently.A Lumbar CT scan indicated disc protrusion,and the patient experienced multiple episodes of fever during this period.Twelve days before admission,the patient developed unexplained swelling pain and numbness in the right lower limb,which persisted despite bed rest.On October 21,2022,tissue and abscess specimens were directly cultured and Gram-stained,along with blood culture,Brucella antibody testing,and CT imaging.Gram staining of the pus sample revealed tiny,sand-like bacterial bodies,suspected to be Brucella species.Paravertebral abscess samples and positive blood cultures were cultured on blood agar plates,yielding Brucella melitensis.Brucella antibody tests were positive.CT scanning of the lumbar vertebrae revealed bone destruction from L3 to L5,with swelling of the paravertebral soft tissues and left psoas muscle.The patient was diagnosed with brucellar spondylitis,with the accompanying paravertebral and psoas abscesses being a rare complication of brucellar spondylitis.Conservative treatment was ineffective,so surgery was performed to relieve nerve compression symptoms,along with the administration of anti-Brucella medication.The patient was discharged 15 days and continued anti-Brucella treatment post-discharge.One year follow-up showed the patient was cured with no recurrence.Brucellosis is characterized by sporadic outbreaks,with atypical clinical symptoms that can easily result in missed or incorrect diagnoses.Timely blood cultures are crucial for early diagnosis and effective anti-Brucella treatment to prevent disease progression and dissemination through the bloodstream,which could lead to multiple organ

关 键 词：布鲁菌 布鲁菌性脊柱炎 椎旁脓肿 血流感染 腰椎间盘突出症 

分 类 号：R529.2[医药卫生—内科学]