Publication:

Long-head biceps tendon rupture as a complication of brucellar tenosynovitis: a rare manifestation of multifocal osteoarticular brucellosis

Brucellosis is a major zoonotic infection in endemic regions and can cause focal osteoarticular complications. Spinal involvement and peripheral septic arthritis are recognised manifestations; however, glenohumeral septic arthritis complicated by long-head biceps (LHB) infective tenosynovitis and tendon rupture is exceedingly rare. A 69-year-old immunocompetent man presented with severe low back pain and right shoulder pain without fever. Initial imaging suggested degenerative lumbar disease and the patient was treated conservatively. One week later, he returned with fever, night sweats, anorexia, worsening bilateral sciatica, and markedly restricted shoulder motion. Inflammatory markers were significantly elevated (CRP 121 mg/l; ESR 74 mm/h), and aerobic blood culture grew Brucella spp., with Brucella serology titre of 1:320. He subsequently reported raw camel milk consumption one month prior. MRI demonstrated L5-S1 spondylodiscitis, right glenohumeral joint effusion with synovial thickening, loculated fluid within the LHB tendon sheath, and complete proximal-third LHB tendon rupture. Lumbosacral MRI confirmed spondylodiscitis without epidural abscess or neurological compromise. Spine management was conservative. Arthroscopic shoulder debridement confirmed infective synovitis, yellowish intra-articular fluid, and complete LHB rupture. The patient received intravenous gentamicin, ceftriaxone, oral doxycycline, and rifampicin. At two months, shoulder pain had resolved, range of motion was almost full, back pain had improved, and CRP had normalised with no documented recurrence. This case represents a rare multifocal presentation of osteoarticular brucellosis and highlights the importance of early microbiological investigation in endemic regions when systemic symptoms coexist with severe musculoskeletal pain. Infective tenosynovitis should be considered a potential contributor to tendon rupture in patients with confirmed brucellosis. Multidisciplinary management is essential.