Brucellosis of the carpus. Report of a case.

Brucellosis is typically a systemic febrile illness and has been well documented since first described in 1861 (Marston 1863). Bone and joint brucella infection is rare; the first case was recorded in 1932 by Kulowski and Vinke. Since then sporadic reports have appeared, these implicating Brucella melitensis more commonly than Brucella abortus. Infection may present as osteomyelitis or arthritis. Vertebral bodies, particularly in the lumbar region, are the usual bones involved, but almost any bone may be affected (Steindler 1940; Lowe and Lipscomb 1947 ; Adam, Macdonald and Mackenzie 1967). Brucellosis of the carpal bones is very unusual (Botreau-Roussel and Huard 1931 ; Hardy, Jordan and Borts 1936; Janbon and Bertrand 1953 ; Arct 1970). Arthritis typically affects largejoints, the hip being most commonly affected (Coventry, Ivins, Nichols and Weed 1949). Monarticular arthritis with associated osteomyelitis involving a peripheral joint is much rarer. Prepatellar bursitis (Johnson and Weed 1954) and subacromial bursitis (Kennedy 1904) also occur. Lowbeer (1949) first described the histology of brucella osteomyelitis as characterised by 1) granuloma with mononuclear reaction ; 2) large foreign body type giant cells of bizarre appearance, though some resembling Langhans’ giant cells ; 3) widespread caseous necrosis (involving the spine in three of his four cases) ; and 4) scar formation and repair with new bone formation.