Coexistence of pancreatic tuberculosis with systemic brucellosis: a case report

Abstract

<jats:title>Abstract</jats:title><jats:p>Isolated pancreatic tuberculosis is an extremely rare clinical entity and is difficult to diagnose particularly in immunocompetent individuals. Clinical findings and symptomatology of brucellosis are often similar to tuberculosis thus making the differentiation amongst the two entities difficult. We report a case of pancreatic tuberculosis with systemic brucellosis in a 29 year old veterinarian who presented with epigastric pain and loss of appetite. Initial investigations revealed leukocytosis with moderately elevated transaminase, gamma glutamyl transferase, amylase and lipase levels. Imaging studies revealed an anechoic multiloculated cyst in the body and tail of the pancreas. Given the patient’s occupational risk coupled with the presence of a positive Brucella agglutination test (with a titer of 1:320); a diagnosis of pancreatitis secondary to brucellosis was given. In addition to standard pancreatitis therapy of bowel rest with intravenous fluid/electrolyte replacement, anti-brucellosis therapy was also administered. The patient’s initial response to therapy was positive however, 6 weeks into therapy, his abdominal pain recurred and repeat CT scan revealed the development of a pseudocyst in the pancreas. After failing a second attempt at conservative supportive therapy, the patient underwent an explorative laparotomy. Histological examination of the resected pancreatic specimen showed necrosis and was positive for tuberculosis by polymerase chain reaction. Herein, we describe the first case reported in the medical literature of the coexistence of systemic brucellosis with pancreatic tuberculosis. We suggest that the possibility of the coexistence of brucellosis with tuberculosis be kept in mind when assessing pancreatitis patients in endemic regions and in individuals with occupational risk hazards.</jats:p>

A case of Brucella pyelonephritis: a rare case

“…This case also showed that when kidney involvement is present in brucellosis, urinary system infection could be also observed [7][8][9]. It was reported that renal involvement in brucellosis would improve without sequelae with appropriate treatment [9][10][11]. In addition, the presented case had symptoms of fever with rigors, left flank pain, and dysuria.…”

“…Although it is rare, brucellosis may present different focal complications in the urinary system. In the current literature although despite its rarety, it has been reported that pyelonephritis due to Brucella species may occur in different forms of brucellosis [7][8][9][10][11]. With this case presentation, we aimed to contribute the literature a case of Brucella pyelonefritis, who had complaints mimicking acute bacterial pyelonephritis.…”

“…The entire literature on brucellosis pyelonephritis consists of only a limited number of reported cases. Therefore, there is no clear consensus on clinical findings, diagnosis, treatment and management [7][8][9][10][11][12]. It has been reported that pyelonephritis may form as a complication of Brucella endocarditis or direct involvement [9].…”

“…Due to the rarity of the Brucella pyelonephritis there is no consensus on its treatment [7][8][9][10][11]. Doxycycline, streptomycin, rifampicin are the first choice antibiotics in the treatment of general brucellosis.…”

Brucellosis Presented as Thyroiditis: A Rare Case Report

“…[16] [17]. The gold standard method in diagnosing brucellosis is blood culture, however, sensitivity is low among chronic cases.…”