Brucellosis is a zoonosis acquired direct contact with infected animals or by consumption of unpasteurized animal by-products. The most common complications involve the musculoskeletal system, such as sacroiliitis or vertebral osteomyelitis. However, skin and soft tissue involvement is uncommon, and cervical abscess are rarely reported. We report the case of a 19-year-old male patient, with no medical history, from the metropolitan region of Caracas, Venezuela, with no history of travel or direct contact with farm animals, but regular consumption of cheese. In July 2024, he presented with undulating fever, hypor1exia and general malaise. One month later his fever intensified, preceded by chills, followed by the development of a painful, erythematous, warm swelling in the anterior neck, which evolved into an abscess requiring drainage. Purulent material yielded Brucella abortus biovar 1 confirmed by Polymerase Chain Reaction (PCR). The patient received Rifampicin and Doxycycline with full recovery. To our knowledge, this is the first recorded case of human brucellosis with this presentation in Venezuela, and the first reported case of cervical abscess caused by Brucella abortus. These findings underscore the importance of maintaining epidemiological surveillance of brucellosis and strengthening quality control and hygiene measures throughout the dairy production and distribution chain.

Guillain-Barré syndrome (GBS) is a rare autoimmune disorder characterized by peripheral nerve involvement. Among the many kinds of GBS, acute motor axonal neuropathy (AMAN) syndrome has been shown to have distinct clinical characteristics and consequences. Meanwhile, ankylosing spondylitis (AS) is a long-term inflammatory joint illness that mostly affects the sacroiliac joints and the spine; this disorder has been known to cause discomfort and stiffness, which may lead to decreased flexibility over time. Some studies have found a link between anti-TNF α medication and GBS. GBS was commonly related to anti-TNF-α treatment for established AS, which explains the rare overlap of both diseases. In our case, nevertheless, both conditions occurred together without any confirmed therapeutic or infectious provocation. We describe a case of a 35-year-old painter hospitalized with paralysis of the lower and upper limbs but normal reflexes. Electromyography (EMG) demonstrated axonal motor neuropathy, and a lumbar puncture revealed high protein levels (42.2 mg/dL) and a normal cell count, all of which are indicators of GBS; hence, he was diagnosed with AMAN. Additional testing revealed human leukocyte antigen (HLA)-B27 positive and bilateral sacroiliitis on magnetic resonance imaging (MRI), which is consistent with AS. The administration of plasma exchange (PLEX) treatment improved the bulbar function.

Background and clinical significance: Autoimmune hepatitis (AIH) and ankylosing spondylitis (AS) are distinct immune-mediated disorders that only rarely coexist. Diagnostic interpretation becomes especially challenging when the liver biochemistry is not classically hepatocellular and the histology is unavailable. Case presentation: We report a 51-year-old man with inflammatory back pain, polyarthralgia, weight loss, fatigue, night sweats and fever. Laboratory tests showed marked systemic inflammation, anemia and a cholestatic-predominant liver profile with associated aminotransferase elevation. Imaging demonstrated bilateral sacroiliitis and syndesmophytosis. Liver workup excluded viral, obstructive, metabolic, hereditary and inflammatory bowel disease-associated cholangiopathic causes. Antinuclear antiboidies (ANA) and anti liver cyotsole 1 antiboidies (anti-LC-1) were positive, IgG was mildly elevated, magnetic resonance cholangio-pancreatography (MRCP) was negative for primary sclerosing cholangitis and the simplified AIH score was six. A liver biopsy was proposed but refused. The patient received a short course of prednisone for rheumatologic flare control, followed by nonsteroidal anti-inflammatory treatment and sulfasalazine, with normalization of liver tests during follow-up. Conclusions: This case is suggestive, but not diagnostic, of autoimmune hepatitis in a patient with ankylosing spondylitis. In the absence of histology and in the setting of a cholestatic-predominant biochemical profile, the findings may be more appropriately interpreted as an autoimmune hepatitis-like syndrome. The main teaching point is that abnormal liver tests in AS warrant structured evaluation beyond drug toxicity and viral hepatitis, particularly when autoimmune serology is positive, even in a cholestatic-predominant presentation.

[This corrects the article DOI: 10.7759/cureus.102986.].

Accurate assessment of sacroiliac joint disease activity is essential in axial spondyloarthritis. We evaluated the safety and diagnostic utility of quantitative and semiquantitative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) parameters together with ZOOMit-DWI-derived apparent diffusion coefficient (ADC) values for distinguishing active from inactive sacroiliitis. Patients with sacroiliitis confirmed by Assessment of SpondyloArthritis International Society criteria were prospectively enrolled between April 2019 and December 2020 and classified as active (Ankylosing Spondylitis Disease Activity Score-C-reactive protein ≥ 2.1) or inactive (Ankylosing Spondylitis Disease Activity Score-C-reactive protein < 2.1); age- and sex-matched healthy individuals served as controls. Quantitative DCE-MRI parameters (volume transfer constant [Ktrans], rate constant, extravascular extracellular volume fraction [Ve]) and ADCs from bone marrow and synovial regions, along with semiquantitative metrics (initial area under the gadolinium concentration-time curve [iAUC], fraction of enhancing voxels [Fenh], signal enhancement, time to peak), were extracted. Compared with the inactive group, the active group showed higher sacral Ktrans, Ve, and ADC; higher iliac Ktrans and Ve; and higher synovial Ktrans (all P < .05). Semiquantitative sacral iAUC and Fenh, iliac iAUC and Fenh, and synovial iAUC were also significantly elevated in the active group (all P < .05). Multivariable logistic regression identified sacral Ktrans, sacral Fenh, iliac iAUC, and synovial iAUC as independent predictors of activity, yielding areas under the receiver operating characteristic curve of 0.9317, 0.7937, 0.8794, and 0.7124, respectively. These findings suggest that combined quantitative and semiquantitative DCE-MRI parameters provide a noninvasive and accurate basis for predicting sacroiliac joint activity.