Complex Brucellosis with Cervical Spine Abscess and Orchitis: A Case Report Highlighting Diagnostic and Management Challenges in Iraq

Abstract

Brucellosis, a significant zoonotic infection, is characterized by protean manifestations that can make timely diagnosis difficult. This case report details a severe and atypical presentation of brucellosis in a 41-year-old male from a rural area in Kirkuk, Iraq, a region where the disease is endemic. The patient presented with a one-month history of debilitating upper back pain, fever, and constitutional symptoms. His condition was complicated by the formation of large para-vertebral and epidural abscesses in the cervical spine. For which he was treated with empirical antibiotics, but his symptoms persisted, and he subsequently developed acute brucellar orchitis. The diagnosis was ultimately established through serological testing, as blood cultures remained negative. This case underscores the critical importance of including brucellosis in the differential diagnosis for patients from endemic areas presenting with complex, multisystemic inflammatory conditions, particularly severe osteoarticular infections and genitourinary involvement. The patient responded well to a prolonged, multidrug antibrucellar regimen, resulting in a favorable outcome.