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• Brucellosis as a cause of carpal tunnel syndrome
  Bonifacio Alvarez Lario
  Published on: 13 April 2016

• Published on: 13 April 2016

  Brucellosis as a cause of carpal tunnel syndrome

  • Bonifacio Alvarez Lario
  • Other Contributors:
    • José L. Alonso and Jesús Macarrón*

  Dear Editor,

  We read with great interest the recent paper by Pappas et al. [1] and we would like to add some considerations about brucellosis as a cause of carpal tunnel syndrome (CTS).

  Brucellosis has been an endemic disease in Castilla y León (Spain) until the 1990’s. In 1992 we reported a series of 44 cases of brucellosis with musculoskeletal manifestations diagnosed in the division of rheumatology of...

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  Dear Editor,

  We read with great interest the recent paper by Pappas et al. [1] and we would like to add some considerations about brucellosis as a cause of carpal tunnel syndrome (CTS).

  Brucellosis has been an endemic disease in Castilla y León (Spain) until the 1990’s. In 1992 we reported a series of 44 cases of brucellosis with musculoskeletal manifestations diagnosed in the division of rheumatology of the Hospital General Yagüe of Burgos between 1988 and 1991 [2]. Seven of them (15.9%) had CTS, confirmed by nerve conduction studies, concurrently with the clinical picture of brucellosis. They were five males and two women. Four of the patients were stockbreeders, one was a butcher, another was slaughterhouse worker, and a last one used to drink not-pasteurized milk. The time from the beginning of the symptoms to the diagnosis of brucellosis was less than three months in five of the patients and more than a year in the other two. Four patients had bilateral CTS. In one case, CTS was the only manifestation of brucellosis.

  Three patients had flexor tenosynovitis and/or wrist arthritis considered as the cause of the CTS; in the other four, with not evident local inflammation, the suggested cause of compression of the median nerve could be a subclinic joint or tendinous affectation or a peripheral neuropathy due to brucellosis. Two patients were submitted to carpal surgical decompression of the median nerve. In both cases there was a significant infiltrate of lymphocytes and plasma cells, with microgranulomas in one. Antibiotic treatment for brucellosis was effective in all of the patients except the one with the more chronic evolution, who sustained a nervous residual damage in spite of antibiotic and surgical treatment.

  Our belief is that CTS associated with brucellosis could be more frequent than one would found reported in the literature, and sometimes can be the only clinical manifestation of brucellosis. As Pappas et al., we emphasize that brucellosis should be included in differential diagnosis of CST in countries where the disease is endemic. Furthermore, this disease has to be considered in those cases in which the pathological study shows a dense infiltrate of lymphocytes and plasma cells and/or microgranulomas.

  B Alvarez Lario, JL Alonso, J Macarrón*
  Division of Rheumatology and Neurology*
  Hospital General Yagüe. Burgos. Spain.

  References

  1. Pappas G, Markoula S, Sitaridis S, Akritidis N, Tsianos E. Brucellosis as a cause of carpal tunnel syndrome. Ann Rheum Dis 2005; 64: 792-793.

  2. Alvarez Lario B, Alonso JL, Alegre J, Vidal J. Síndrome del túnel carpiano asociado a brucelosis. Rev Esp Reumatol 1992; 17: 185-186.

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  Conflict of Interest:
  None declared.

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