Acute brucellosis associated with isolated splenic and left gastric artery vasculitis and acute ischemic bowel infarction. A systematic review of the most recent cases

Abstract

Brucellosis is a multisystem bacterial zoonosis caused by Gram-negative bacteria Brucella spp. Ingestion of infected food products, direct contact with an infected animal, or inhalation of aerosols are all ways for germs to spread from animals to humans. Intestinal vasculitis with gangrene due to brucellosis has rarely been reported. We report a 62-year-old male patient presenting with acute onset of recurrent attacks of abdominal pain, remittent fever, malaise, and weight loss, which were followed by severe left hypochondrium abdominal pain with rigidity and signs of acute abdomen. Brucellosis was clinically suspected and confirmed by an enzyme-linked immunosorbent assay against the Bru-SUMMARY cella melitensis species. An abdominal CT scan revealed isolated splenic and left gastric artery vasculitis, leading to acute bowel ischemia, bowel infarction and gangrenous jejunal bowel segment. Histopathological examination of the resected gangrenous bowel segment revealed leucocytoclastic vasculitis. The patient was successfully treated with a standardized antimicrobial therapy for brucellosis and a short course of steroids with a complete resolution of the symptoms and signs. The case is discussed and the literature is reviewed.

Acute Brucella infection associated with splenic infarction: a case report and review of the literature

“…The spleen has much fewer hypodense lesions than the former. Saad et al, 2021). The reason for the splenic infarction in our patient was probably due to the rapid enlargement of the spleen, or it could have been caused by vasculitis.…”

“…Among the previously reported eight patients with brucellosis complicated with splenic infarction. There were only three cases combined with vasculitis, two of which were confirmed by histological examination in two cases ( Uçmak et al., 2014 ; Wang et al., 2017 ; Saad et al., 2021 ). The reason for the splenic infarction in our patient was probably due to the rapid enlargement of the spleen, or it could have been caused by vasculitis.…”

“…Because there is no pathological examination, the cause of the splenic infarction is unknown. Therefore, we need to add Brucella infection to the differentiation of vasculitis and splenic infarction as well ( Saad et al., 2021 ).…”

Early diagnosis and treatment of acute brucellosis knee arthritis complicated by acute osteomyelitis: two cases report

“…In this report, both patients had traveled to the areas endemic with brucellosis. The second patient handled sheep with hands that had broken skin; while the first patient only ate the undercooked mutton, the possibility of aerosol transmission also exists [ 12 ]. Acute osteomyelitis is mainly caused by hematogenous infection in adults, rarely through local spread of infection [ 13 ].…”