Brucellar spondylodiscitis frequently poses diagnostic challenges due to its atypical early clinical manifestations, which may mimic degenerative spinal diseases. This report described a 42-year-old male patient who initially presented with severe low back pain and acute cauda equina syndrome and was preoperatively diagnosed with lumbar disc herniation. Emergency lumbar decompression was performed; however, the patient later developed fever and systemic symptoms. Repeated serological testing confirmed brucellosis. The early clinical, laboratory, and imaging features were nonspecific, and initial inflammatory markers and bacterial cultures were negative. Empirical levofloxacin may have masked inflammatory responses. This case highlights the importance of maintaining high index of suspicion for brucellar spondylodiscitis in endemic regions, even in the absence of systemic signs of infection. Repeat serologic testing, careful radiological evaluation, and attention to epidemiological exposure are critical for early and accurate diagnosis.
Han et al. (Fri,) studied this question.