Sacroiliitis Due to Brucella melitensis

Figure 1

Magnetic resonance imaging of the lumbar spine (coronal STIR sequence): the arrow points at the left sacroiliac joint with marked signal hyperintensity, consistent with inflammation. Photo: Zentrum für Radiologie, Klinikum Kassel, Dr. med. C. Trieschmann

A 24-year-old previously healthy patient presented with a 2-week history of atraumatic, left-sided low back pain. In the month prior to admission, the patient had experienced two episodes of mildly elevated temperature, but was afebrile upon hospital admission. Laboratory tests showed moderately elevated inflammatory markers, while magnetic resonance imaging revealed left-sided sacroiliitis. Upon recurrence of fever, culture testing rapidly detected Brucella melitensis (time to positivity [TTP] was 65 h, 2/2 blood cultures were positive). Echocardiography ruled out Brucella endocarditis. This was followed by 12 weeks of oral treatment with doxycycline and rifampicin, resulting in freedom from symptoms and normalization of inflammatory markers. MRI showed improvement in sacroiliitis. The patient had traveled to Macedonia 6 months earlier and consumed unpasteurized sheep’s milk. Sacroiliitis is a rare manifestation of brucellosis, which is uncommon in Germany but endemic in many southern European countries. In view of increasing global mobility, brucellosis needs to be considered in the differential diagnosis in patients with a relevant travel history. Serological testing (IgM/IgG antibodies) is recommended, given the low sensitivity of blood cultures. If brucellosis is suspected, the laboratory must be notified to ensure longer incubation periods (5–7 days) and appropriate personnel protection.

Anna Isenmann, Klinik für Nieren-, Hochdruck-, und Rheumatische Erkrankungen und Nephrologische Diabetologie, Kassel, [e-mail]

Dr. med. Marcus W. Thomé, Infektionsdiagnostik und Klinische Mikrobiologie, Institut für Labormedizin, Kassel

PD Dr. med. Alexander Reshetnik, Medizinische Klinik mit Schwerpunkt Nephrologie und Internistische Intensivmedizin, Charité – Universitätsmedizin Berlin; Klinik für Nieren-, Hochdruck- und Rheumatische Erkrankungen und Nephrologische Diabetologie, Kassel

Conflict of interest statement: The authors declare that no conflict of interest exists.

Translated from the original German by Christine Rye.

Cite this as: Isenmann A, Thomé MW, Reshetnik A: Sacroiliitis due to Brucella melitensis. Dtsch Arztebl Int 2026; 123: 77a. DOI: 10.3238/arztebl.m2025.0189