A case of lumbar sciatica in a patient with spondylolysis and spondylolysthesis and underlying misdiagnosed brucellar discitis

We report the case of a patient affected by vertebral pain refractory to conventional analgesic therapy with a diagnosis of spondylolysthesis and also the affects of a misdiagnosed brucellar spondylodiscitis. The absence of a positive response to conventional analgesics, a suggestive medical history (epidemiologic data still show a high incidence of Brucella infections for the Province of Catania), radiological findings and microbiological tests led to the correct diagnosis of algic syndrome in a patient affected by brucellar spondylodiscitis with the concomitant presence of retroperitoneal muscular abscess, and a previously diagnosed spondylolysthesis. All symptoms improved after correct antibrucellar antibiotic therapy and surgical drainage of the retroperitoneal abscess. Vertebral pain is a relatively frequent symptom observed in Pain Medicine Services; in a zone in which Brucella infections may be considered endemic, neurobrucellosis must be considered highly probable in the differential diagnosis of several clinical pictures, including vertebral pain that could result from vertebral localization of Brucella infection. The role of the Pain Medicine Specialist is not only to treat the symptoms, but also to research and confirm the etiopathogenetic mechanisms before starting a correct treatment.