Extensive Cervicothoracic Spinal Cystic Echinococcosis: A Rare Case Misdiagnosed as Brucellosis

Spinal involvement in cystic echinococcosis (CE), which is caused by the Echinococcus granulosus , mostly results from direct extension from visceral foci, even while primary involvement of the disease is possible without any identifiable focus. A 58-year-old man presented with progressive back pain, bilateral lower-extremity weakness, and urinary incontinence following a fall. Imaging demonstrated extensive cervicothoracic (C7–T10) epidural and paraspinal cystic lesions associated with a pathological T9 compression fracture and severe spinal cord compression. Emergency posterior decompression and stabilization were performed. Initial microbiological findings suggested brucellosis; however, histopathological examination revealed CE. The patient received postoperative albendazole therapy and remained neurologically stable during 12 months of follow-up without radiological progression. Extensive spinal CE should be considered in the differential diagnosis of destructive spinal lesions, particularly in endemic regions, even when initial microbiological investigations are misleading. To our knowledge, reports describing such extensive cervicothoracic spinal involvement initially misdiagnosed as brucellosis are exceedingly rare.