Is an MRI of the lumbar region indicated for a patient with brucellosis who has completed 2 months of antibiotics and has 1 month remaining, with symptoms in the right thigh?

MRI of the Lumbar Spine is Indicated for Brucellosis Patients with Right Thigh Symptoms

MRI of the lumbar spine is strongly indicated for a patient with brucellosis who has completed 2 months of antibiotics and has symptoms in the right thigh (lateral aspect), as spinal involvement is a common complication requiring thorough evaluation and potentially extended treatment. 1

Rationale for Lumbar MRI in This Case

Clinical Presentation Suggesting Spinal Involvement

• Right thigh pain (lateral aspect) in a brucellosis patient strongly suggests potential lumbar spine involvement with possible nerve root compression or radiculopathy
• Back pain and sciatica radiculopathy are the most common complaints in patients with brucellar spondylodiscitis 2
• Spondylodiscitis most frequently affects the lumbar region (especially L4-L5 levels) 2

Imaging Recommendations for Suspected Spinal Brucellosis

• MRI of the spine is mandatory when spinal involvement is suspected, regardless of the spinal level affected 1
• The American College of Radiology recommends MRI as the imaging modality of choice for suspected neurobrucellosis 1
• Spine MRI should include:
  • Sagittal T1-weighted pre- and post-contrast sequences
  • Sagittal and axial T2-weighted sequences
  • Fat-suppressed post-contrast T1-weighted images 1

Clinical Implications of Spinal Brucellosis

Diagnostic Findings on MRI

• Spondylodiscitis with T2 hyperintensity in the disc and adjacent vertebral bodies
• Potential epidural abscess formation with cord compression
• Possible spinal destructive brucellar lesions 1, 2

Treatment Implications

• If spinal involvement is confirmed, treatment duration needs to be extended:
  • Uncomplicated neurobrucellosis: minimum 3 months of antibiotics
  • Complicated spinal brucellosis (with abscesses): 6 months or longer 1
• The patient has already completed 2 months of antibiotics with 1 month remaining, which may be insufficient if spinal involvement is confirmed

Management Considerations

Treatment Modification Based on MRI Findings

• If MRI confirms spinal involvement, the current antibiotic regimen should be continued for a total of at least 3-6 months 1
• First-line regimen: doxycycline plus rifampicin for 3-6 months, with addition of an aminoglycoside (preferably streptomycin) for the first 2-3 weeks 1

Potential Need for Surgical Intervention

• Surgical intervention should be considered if MRI reveals:
  • Spinal cord compression
  • Spinal instability
  • Presence of abscesses requiring drainage
  • Evidence of treatment failure 1

Monitoring Response

• Regular clinical assessment, inflammatory markers, and follow-up imaging are essential
• Treatment failure rates of approximately 20% have been reported in patients with brucellar vertebral osteomyelitis 1
• Patients should be monitored for at least 12 months after treatment completion to detect relapses 1

The presence of right thigh symptoms in a patient with brucellosis strongly warrants lumbar spine MRI to rule out spinal involvement, which would significantly impact treatment duration and approach.