An unusual presentation of brucellosis, involving multiple organ systems, with low agglutinating titers: a case report

Abstract

BackgroundBrucellosis is a multi-system disease that may present with a broad spectrum of clinical manifestations. While hepatic involvement in brucellosis is not rare, it may rarely involve the kidney or display with cardiac manifestations. Central nervous system involvement in brucellosis sometimes can cause demyelinating syndromes. Here we present a case of brucella hepatitis, myocarditis, acute disseminated encephalomyelitis, and renal failure.Case presentationA 26-year-old man presented with fever, ataxia, and dysarthria. He was a shepherd and gave a history of low grade fever, chilly sensation, cold sweating, loss of appetite, arthralgia and 10 Kg weight loss during the previous 3 months. He had a body temperature of 39°C at the time of admission. On laboratory tests he had elevated level of liver enzymes, blood urea nitrogen, Creatinine, Creatine phosphokinase (MB), and moderate proteinuria. He also had abnormal echocardiography and brain MRI. Enzyme-linked immunosorbent assay for IgG and IgM was negative. Standard tube agglutination test (STAT) and 2-mercaptoethanol (2-ME) titers were 1:80 and 1:40 respectively. Finally he was diagnosed with brucellosis by positive blood culture and the polymerase chain reaction for Brucella mellitensis.ConclusionIn endemic areas clinicians should consider brucellosis in any unusual presentation involving multiple organ systems, even if serology is inconclusive. In endemic areas low STAT and 2-ME titers should be considered as an indication of brucellosis and in these cases additional testing is recommended to rule out brucellosis.

Brucella Myocarditis: A Rare and Life-Threatening Cardiac Complication of Brucellosis

“…According to Colmenero et al, only 1.54 % of 530 brucellosis cases had cardiac involvement-with only one patient having myocarditis (0.2%) (1). Indeed, when we searched in the MEDLINE database for articles published between 1966 and 2011 using the words 'myocarditis' and 'brucellosis', we identified only 11 reports in the English language literature of patients with brucellosis including 13 patients with appropriate information for analysis on brucellosis-related myocarditis in the absence of concomitant endocarditis (5,(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18).…”

Acute renal failure due to Brucella melitensis

“…Brucellosis is a systemic disease which can involve any organ [13,16,[19][20][21][22][23][24]. We present this case to emphasize a rare clinical variation of brucellosis, specifically the development of acute renal failure.…”

“…It can affect people in every age group. There are many clinical studies about multiorgan involvement of the disease [10][11][12][13][14][15][16][17][18][19][20][21][22][23]. Currently, most patients are misdiagnosed with arthritis or other non-specific infections which are important to consider in a differential diagnosis [8,9,11,13,16,21].…”

A Case of Myopericarditis: Very Rare Complication of Brucellosis

“…Another study from Spain revealed that eight out of 530 cases of Brucellosis ( 1.5% of patients) had cardiac involvement and only one of them had pericarditis without concurrent endocarditis (0.2%) (3). Cases of pericarditis or myocarditis without simultaneous endocarditis, which rarely happen, are reported sporadically as case report (4)(5)(6). We searched in the MEDLINE database using the words "myopericarditis" and "brucellosis" and only three articles detected (2,7,8).…”