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A Case of Brucellosis Presented as Pericarditis: Rare Presentation

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Dr Sneha Vadhvana, Dr Manish N Mehta, Dr Aniket Bhardwaj    09 November 2017

Assistant Professor Professor and Head 2nd Year Resident Dept. of Medicine GG Hospital Jamnagar Gujarat Address for correspondence Dr Manish N Mehta Shripati Apt. Valkeshwari Nagri Jamnagar Gujarat E mail mnmehta1968 yahoo.com ABSTRACT Brucella pericarditis is a rare condition with only a few reported cases. We review the literature and describe a 24 year old Indian male patient who was referred to our institute as a case of pyrexia of unknown origin. Patient was admitted with complaints of chest pain sudden onset of breathlessness and severe joint pain. Electrocardiogram showed ST segment elevation with concavity upward and 2D echocardiography of patient was suggestive of pericarditis with pericardial effusion. On history he was found to be a farmer by occupation. We sent his blood for brucella IgM titer which was found to be positive. We treated the patient with antibiotics and steroid therapy. Patient responded well and was discharged with oral antibiotics. Keywords Brucellosis pyrexia of unknown origin pericarditis positive brucella IgM Brucellosis is a bacterial zoonosis transmitted directly or indirectly to humans from infected animals predominantly domesticated ruminants and swine. The disease is known colloquially as undulant fever because of its remittent character. Its distribution is worldwide apart from the few countries where it has been eradicated from the animal reservoir. Although brucellosis commonly presents as an acute febrile illness its clinical manifestations vary widely and definitive signs indicative of the diagnosis may be lacking. Thus the clinical diagnosis usually must be supported by the results of bacteriologic and or serologic tests.1 CASE REPORT A 24 year old Hindu Indian patient by occupation a farmer came to our institute with chief complaints of high grade fever with chills and rigor. Fever was intermittent and relieved after taking some drug. He was having fever since 15 days. Fever was associated with severe multiple joint pain which led to severe disability. Patient was mainly having knee joint pain which was swollen and tender. Patient gave history of ingestion of raw milk. With all above mentioned complains patient was referred to us as a case of pyrexia of unknown origin with all basic reports done which are given in Table 1. We suspected brucellosis. For that brucella IgM immunoglobulin M antibody testing was done which was found to be positive. At same time the patient was complaining of chest pain with breathlessness at rest. On examination there was tachypnea and tachycardia. We had ECG of the patient done which showed ST segment elevation with concavity upward in all chest leads. 2D echocardiography of patient revealed mild pericardial effusion with pericarditis which responded to injectable furosemide with injectable hydrocortisone given for 5 days. Patient was given capsule doxycycline 200 mg b.i.d. for 6 weeks and injection streptomycin o.d. for 2 weeks. Patient s fever subsided completely but the joint pain was still so severe that he could not move. For that we started injectable methylprednisolone for 5 days. Patient improved completely and was discharged. DISCUSSION Human brucellosis is caused by strains of Brucella a bacterial genus that was previously suggested on genetic grounds to comprise a single species Brucella melitensis with a number of biologic variants exhibiting particular host preferences. All brucellae are small Gram negative unencapsulated nonsporulating nonmotile rods or coccobacilli. They grow aerobically on peptone based medium incubated at 37 C the growth of some types is improved by supplementary CO2. In vivo brucellae behave as facultative intracellular parasites. The organisms are sensitive to sunlight ionizing radiation and moderate heat they are killed by boiling and pasteurization but are resistant to freezing and drying. Their resistance to drying renders brucellae stable in aerosol form facilitating airborne transmission.1 Brucellosis can involve almost any organ of the body and can lead to multiorgan dysfunction.2 Our patient was a case of brucella pericarditis. Cardiac complications from brucellosis are unusual occurring in 0 2 of patients and usually manifest as endocarditis.2 4 Here patient was referred to us as a case of pyrexia of unknown origin as patient has went on all investigations except brucella titer before presenting to our institute.5 CONCLUSION Brucella is rare cause of pericarditis but should be considered as one of the cause of bacterial pericarditis. REFERENCES 1. White NJ Bremen JG. Malaria Chapter 157 . In Fauci AS Kasper DL Hauser SL Longo DL Jameson JL Loscalzo et al Eds. . Harrison s Principles of Internal Medicine. 18th Edition New York McGraw Hill 2012. 2. Khorvash F Keshteli AH Behjati M Salehi M Emami Naeini A. An unusual presentation of brucellosis involving multiple organ systems with low agglutinating titers a case report. J Med Case Rep. 2007 1 53. 3. Jubber AS Gunawardana DR Lulu AR. Acute pulmonary edema in Brucella myocarditis and interstitial pneumonitis. Chest. 1990 97 4 1008 9. 4. Garc a de Lucas MD Castillo Dom nguez JC Mart nez Gonz lez MS. Brucella myopericarditis. Rev Esp Cardiol. 2004 57 7 709. 5. Hadda V Khilnani G Kedia S. Brucellosis presenting as pyrexia of unknown origin in an international traveller a case report. Cases J. 2009 2 7969.

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