technetium-tc-99m-medronate and Brucellosis

We report 2 cases of sacroiliitis in a 13-year-old girl and an 11-year-old boy as the sole manifestation of Brucella melitensis infection. This is a rare condition. Throughout the course of the disease, neither the girl nor the boy had other signs of brucellosis. Sacroiliitis was documented by positive results of technetium 99m scintigraphy and magnetic resonance imaging. Isolation of B. melitensis from the blood and positive results of serologic methods established the diagnosis. Treatment consisted of bed rest and a combination of rifampin plus co-trimoxazole with gentamicin. Brucellar sacroiliitis is uncommon in children, and accurate diagnosis is frequently delayed because of nonspecific clinical presentation. In the appropriate clinical setting, we suggest that the index of suspicion for brucellar sacroiliitis be raised in an unusual joint, especially in endemic regions.

Topics: Adolescent; Anti-Bacterial Agents; Brucella melitensis; Brucellosis; Child; Female; Greece; Humans; Magnetic Resonance Imaging; Male; Radiopharmaceuticals; Sacroiliac Joint; Technetium Tc 99m Medronate

Topics: Adolescent; Bone and Bones; Bone Diseases; Bone Neoplasms; Brucellosis; Female; Humans; Radionuclide Imaging; Technetium Tc 99m Medronate

Low back pain is the most frequent rheumatologic manifestation of brucellosis. The diagnosis of brucellar sacroiliitis is hampered by the poor specificity of the clinical data and the poor sensitivity of the radiologic data. In this report, we show that scintigraphy not only increases the sensitivity but also allows an earlier diagnosis of disease and permits the detection of osteoarticular brucellar involvement in areas adjacent to the sacroiliac joint.

Topics: Back Pain; Brucellosis; Diagnosis, Differential; Humans; Prospective Studies; Radionuclide Imaging; Technetium Tc 99m Medronate

Brucellosis is an endemic disease in the Middle East. Its incidence in Kuwait has increased during the last 5 years. Bone and joint involvement causes major symptoms and disabilities. Radionuclide bone scans are more sensitive than radiographs in detecting these lesions. The aim of this study is to describe the abnormal patterns detected on bone imaging in acute and chronic brucellosis. Tc-99m MDP bone scans of 56 patients with established diagnosis of brucellosis (19 acute and 37 chronic) were retrospectively analyzed. Bone scans were positive in 8 of 19 patients (42%) with acute brucellosis and in 28 of 37 patients (76%) with chronic brucellosis. Six patterns were observed: involvement of an entire body of one or more vertebrae, especially at the lumbar region (50%); sacroiliitis (41%); focal high uptake at the junction of the upper and lateral margins of the vertebra "Caries sign" (27%); multiple costovertebral joints and costochondral junction involvement (19%); involvement of large joints similar to degenerative osteoarthritis (25%); and focal involvement of long bone (11%).

Topics: Acute Disease; Adult; Back Pain; Bone Diseases; Brucellosis; Chronic Disease; Female; Humans; Joint Diseases; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate

A case of a 12-year-old boy with sacroiliitis documented by positive Tc-99m MDP and Ga-67 scans is described. Isolation of brucella melitensis from the blood and bone marrow established the diagnosis. He responded promptly to docycycline therapy. Throughout the course of his disease this boy had neither fever nor other signs of brucellosis, and x-ray was normal.

Topics: Arthritis, Infectious; Brucellosis; Child; Gallium Radioisotopes; Humans; Male; Radionuclide Imaging; Sacroiliac Joint; Technetium Tc 99m Medronate