Open Journal of Orthopedics, 2013, 3, 20-22 doi:10.4236/ojo.2013.31005 Published Online March 2013 (http://www.scirp.org/journal/ojo) Periacetabular Brucella Osteomyelitis Hakan Cift 1 , Krishna Reddy 2 , Esat Uygur 3 , Salih Söylemez 3 , Serkan Şenol 4 , Korhan Ozkan 3 , Maria Silvia Spinelli 5 , Abdullah Eren 6 1 Orthopaedics and Traumatology Department, Medipol University, Istanbul, Turkey; 2 Orthopaedics and Traumatology Department, Royal Orthopaedic Hospital, Birmingham, United Kingdom; 3 Orthopaedics and Traumatology Department, Medeniyet University Goztepe Research and Training Hospital, Istanbul, Turkey; 4 Department of Pathology, Medeniyet University Goztepe Research and Training Hospital, Istanbul, Turkey; 5 Orthopaedics and Traumatology Department, University Hospital Agostino Gemelli, Catholic University of the Sacred Heart School of Medicine, Rome, Italy; 6 Orthopaedics and Traumatology Department, Florence Nightingale Hospital, Istanbul, Turkey. Email: hakanturancift@yahoo.com Received December 23 rd , 2012; revised February 5 th , 2013; accepted February 26 th , 2013 ABSTRACT Introduction: Although Brucellosis has a limited geographic distribution; it remains a challenge in certain parts of the world such as in Mediterranean, western Asian, Latin American and African regions. We present a unique case of peri- acetabular Brucella osteomyelitis and increase awareness of possible widespread distrubition of Brucella osteomyelitis and its ability to affect any region of the musculoskeletal system. Case Presentation: A 44-year-old male farmer pre- sented with symptoms of pain radiating from his left hip to his thigh of five years duration. There was a history of night sweats and fever for the past two months. A lytic area with smooth borders in left periacetabular region was detected on pelvic roentgenography of the patient. Magnetic resonance imaging revealed a cavitatory lesion in relation to hip joint. Open biopsy was undertaken with the differential diagnosis of an infectious (Brucella or Tuberculous) or tumoral lesion. Intraoperative frozen sections showed granulomatous inflammatory tissue. Post debridement, the cavity was filled with autograft taken from the patient’s right iliac wing. Postoperative immunohistochemistry confirmed diagnosis of Brucella osteomyelitis. Oral Doxycyline, Rifampicine and Ciprofloxacin were administered for 3 months. At one-year postoperatively, the patient had a painless, unrestricted range of motion and function in relation to the affected hip. Conclusion: In endemic regions, Brucella osteomyelitis should be considered in differential diagnosis in patients with arthralgia and/or spondylodiscitis in the presence of radiologically suspected osseous lesions. Keywords: Brucella; Acetabulum; Osteomyelitis 1. Introduction Brucella is a Gram-negative coccobacillus [1]. Although the clinical presentation of Brucella is usually non-spe- cific, its musculoskeletal involvement is frequent [1-2]. The frequency of osteoarticular involvement of Brucella ranges between 10% - 85% and the most frequent os- teoarticular involvements are seen in the form of arthritis, spondylitis, bursitis, tenosynovitis and osteomyelitis [3-6]. Brucella osteomyelitis may appear as a radiolucent area and it may be confused with tumour lesion on ra- diographs. Thus, care should be given during diagnosis of etiology of the lesions [7]. 2. Case Presentation A 44-year-old male farmer and animal breeder presented to our hospital with complaints of severe hip pain limit- ing his ability to walk, five years history of left hip/thigh pain radiating to his calf. The patient was initially exam- ined in different centers and he had been diagnosed with lumbar disc disease and treated as such with anti-in- flammatory medication with no relief. He also had two-month history of night pain and fever. Physical ex- amination of the patient revealed severe pain during in- ternal and external rotation of his left hip. A well-cir- cumscribed lytic lesion was seen in the patient’s left peri-acetabular region on radiograph (Figure 1). Mag- netic Resonance (MR) imaging on T2 sequences demon- strated a caviatory fluid filled lesion in the anterosuperior acetabular ridge in the left peri-acetabular region (Figure 2). The patient was hospitalized with a possible diagnosis of infectious (Tuberculosis/Brucella osteomyelitis) or a neoplastic lesion. Further examination of the patient displayed a C-reac- tive protein of 6.35 mg/dL (Normal: 0.00 - 0.800). The patient underwent an open biopsy. The lytic area was accessed by an incision from the superolateral acetabu- Copyright © 2013 SciRes. OJO