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Differential Diagnosis

Because of the clinical condition of the patient it is unlikely that brucellosis will be mistaken for an acute pyogenic osteomyelitis; it is especially likely that it will be thought to be tuberculosis. The central foci in the vertebral bodies are indistinguishable from the similar lesions of tuberculosis. The early involvement and loss of the disc space is very suggestive of brucellosis, and the rapid hypertrophic reaction with new bone formation is also helpful. Unfortunately, spur formation may also occur in tuberculosis of the spine in a matter of a few weeks and mimic brucellosis in every way, although the disc spaces usually remain intact somewhat longer in tuberculosis. Paraspinal and psoas abscess formation is rarely seen in pyogenic osteomyelitis, but occurs not infrequently in brucellosis, although less commonly and less extensively than in tuberculosis. The paravertebral abscess of brucellosis seldom calcifies.

Elsewhere in the skeleton the bony foci are indistinguishable from tuberculosis; the diagnosis has to be made clinically and serologically and, in some cases, on histological examination. Even this may be difficult, but brucellosis is a noncaseating granulomatous process, which establishes the diagnosis. In the tropics, many patients with skeletal tuberculosis will have an active chest infection or other evidence of tuberculosis, and this is nearly always absent in brucellosis. Clinically, the pattern of the fever and the general condition of the patient may be significant. In the later stages, accurate radiological diagnosis remains difficult and the hypertrophic spur formation may be sufficiently great even to be confused with degenerative osteoarthritis.

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Copyright: Palmer and Reeder


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