An Unusual Case of Brucellosis in Japan: Difficulties in the Differential Diagnosis from Pulmonary Tuberculosis.

Abstract

Humanbrucellosis is an imported zoonosis extremely uncommonin Japan. Brucellosis was found in a 38-year-old surgeon who had never been abroad; he developed intrapulmonary infiltrates and pleural thickening indistinguishable from pulmonary tuberculosis. Despite extensive antibiotic therapy for tuberculosis he developed systemic serositis. A culture of resected lung tissues grew CO2-required coccobacilli. Polymerase chain reaction test using a specific primer pair for Brucella abortus revealed that the isolated pathogen is highly homologous to B. abortus. We emphasize that undetermined cases of humanbrucellosis maybe present in Japan.

Brucella Endocarditis in a Non-Endemic Country First Reported Case in East Asia

“…Moreover, in some cases, it may be difficult to distinguish between human brucellosis and tuberculosis. 6 In the present case, the lack of suspicion and the relatively low incidence of human brucellosis in East Asia resulted in a diagnostic delay.…”

Brucellosis of the lung: case report and review of the literature

“…The most frequently affected organs are the liver, bones, endocard and soft tissues (Table 1). Pleuropulmonary manifestations and their histology are described in different case reports [2,4,8,16,[19][20][21][22]. Tuberculosis-like changes are dominant, and men are more often affected ( Table 2).…”

“…In these cases, clinical investigations are necessary to prove or exclude brucellosis. Successful diagnosis depends on the verification by microbiological means, usually by culture or serology [15,[19][20][21]. A negative CFT does not necessarily exclude brucellosis [15,24].…”

“…Sacroiliitis developed after ending medication. Serology remained negative at this time (IgG in enzyme-linked immunosorbent assay [ELISA]<5 U/ml, questionable 20-30; IgM ELISA<5 U/ml, questionable [15][16][17][18][19][20]. Antimicrobial treatment was continued.…”

“…Focal manifestations are found in joints and bones (spondylitis, sacroiliitis, arthritis), the respiratory tract (pneumonia, pleuritis), in the cardiovascular (endocarditis, pericarditis, vasculitis), and nervous system (radiculitis, meningoencephalomyelitis), in the urogenital system (nephritis, epididymitis, orchitis) as well as in the liver, spleen and the skin [3,5,14,25]. Histology of brucellosis shows a granulomatous reaction; additionally, uncharacteristic features are described [1,2,8,11,16,[18][19][20][21][22], which can be seen in a large number of other lung diseases as well [6,12].…”