A rare case of brucellosis with dermatomal pattern of cutaneous manifestation

Brucellosis is a systemic disease which may involve any organ or system of
the body, and is listed in the differential diagnosis of many diseases. In spite of described
cutaneous involvements, skin manifestations are not common in brucellosis, particularly
papulonodular lesions with dermatomal patterns that may overlap with dermatomal skin
lesions. This may prevent correct diagnosis and treatment in practice, harming patients’
health and leading to financial costs to the health system and patient. In this case, at first,
due to left thigh and buttock skin lesions and dermatomal pattern, the patient was
diagnosed with Herpes zoster infection. After medical treatment and no improvement
of lesions, the patient was referred to the infectious clinic with low back pain; magnetic
resonance imaging (ordered by a neurosurgeon) suggested infectious spondylodiscitis. At
the infectious ward, brucellosis spondylitis was diagnosed and a biopsy was taken from
dermatomal lesions. The patient’s follow-up after 1, 2, and 3 months revealed that
treatment of brucellosis had led to healing of lesions. Surprisingly, the histopathological
assessment of the biopsy suggested psoriasis vulgaris. This was a rare case of manifesta-
tion of cutaneous brucellosis which could not even be diagnosed by histopathological
assessment.