A Case of Brucellosis Presenting with Multiple Hypodense Splenic Lesions and Bilateral Pleural Effusions

Abstract

Brucellosis is a zoonotic infectious disease, which mainly present with lymphoreticular system invovement. However any organ system can be attacked by the microorganism. In this paper we present a 52-year-old female patient who was admitted to the Infectious Diseases Department with complaints of fatigue, arthralgias, fever, and weight loss. In the medical examination and radiological analysis bilateral pleural effusions and hepatosplenomegaly were detected. Serum transaminase levels were two times higher than the upper limits of normal. Abdominal ultrasound revealed sludge in the gallbladder and multiple hypodense splenic lesions (the largest was 1 cm in diameter). Brucella melitensis was isolated from the blood culture of the patient. Rifampicin (600 mg/day) and doxycycline (200 mg/day) therapy was started. Follow-up chest radiography and ultrasonography revealed the absence of pleural effusion. Splenic lesions and hepatosplenomegaly were totally regressed. The patient has been followed for 3 months after 6 week antibiotic regimen without recurrence. Brucellosis was expected to be the cause of all pathological signs.

Splenic abcess owing to brucellosis

“…Pulmonary involvement secondary to bacteraemia has also been seen in brucellosis and can rarely manifest as empyema, pleural effusions, pulmonary nodules and mediastinal lymphadenopathy 8. Although our patient had a single episode of unwitnessed haemoptysis, there was no evidence of pulmonary involvement on the chest radiography or CT scan.…”

Hepatosplenic brucella abscesses on computed tomography and magnetic resonance imaging

“…Two similar findings had also been reported by others. [19,20] Solitary abscess had calcification, but multiple smaller abscesses showed few calcifications. [18] Our study reported CT examination showed no calcification with multiple smaller abscesses in the spleen or liver.…”

A 28-Year-Old Woman with Fever, Weight Loss, Pancytopenia, and Multiple Hepatosplenic and Bone Lesions

“…These focal forms may include osteoarticular, neurological, genitourinary, liver, hematological, and cardiac involvements [ 2 ]. Brucella bacteremia can also cause abscess formation in the spleen, liver, or other organs [ 5 ]. Nevertheless, some forms of focal involvement such as hepatosplenic abscesses and multifocal or extraspinal osteomyelitis have rarely been seen and they are quite uncommon.…”

“…Our report also described a rare presentation of acute brucellosis with bacteremia and multiple hepatosplenic lesions. Although hepatomegaly and splenomegaly are frequent findings on physical examination, a more unusual complication of human brucellosis is the development of abscesses of the liver and spleen [ 5 ]. In a study by Colmenero et al hepatosplenic abscesses were detected in 0.8% of 805 patients [ 9 ].…”

“…In Turkey, Pourbagher et al [ 11 ] reviewed 251 cases of brucellosis and identified splenic abscess in 1.6% of cases with an ultrasound. Other rare complications associated with splenic involvement in brucellosis include splenic infarction, [ 12 , 13 ], splenic subcapsular hematoma, and spontaneous splenic rupture [ 5 ]. Most patients with hepatic and splenic abscess due to brucellosis have chronic infection.…”