A Case of Brucellosis with Possible Ileal Involvement

Brucellosis, a diagnostic dilemma, presenting atypically in a child with terminal ileitis: A case report

BACKGROUND

Brucellosis is endemic in India with seropositivity rates as high as 10% in children in the eastern states, yet the disease is not on the radar when a differential diagnosis of pyrexia of unknown origin (PUO) is being considered, especially in children in urban set-up. This may be because of the non-specific multitude of systemic symptoms seen in this disease and the lack of awareness among clinicians.

CASE SUMMARY

We present a case of a 13-year-old boy, who came with a history of undulating fever for the past three and a half months, loss of appetite, and abdominal pain. The child had visited several pediatricians and was even admitted to a tertiary care hospital for PUO evaluation, but to no avail. He presented to us after three and half months of suffering and weight loss of more than 10% of body weight. His ultrasonography revealed thickening of the terminal ileum. His blood culture grew Brucella melitensis. A diagnosis of Brucellosis with terminal ileitis was made. Brucella serology by enzyme-linked immunoassay (ELISA) was positive for both IgG and IgM. He was treated with doxycycline and Rifampicin along with syrup multivitamin and zinc, for 6 wk. There was remarkable improvement with gain in 4 kg body weight within 2 mo of completing treatment. History revealed consumption of unpasteurized milk and contact with cattle.

CONCLUSION

Clinical suspicion, detailed history, appropriate laboratory investigations are the three pillars for diagnosing Brucellosis in patients presenting with vague symptoms.

Abdominal Lymphadenopathies: Lymphoma, Brucellosis or Tuberculosis? Multidisciplinary Approach-Case Report and Review of the Literature

Abdominal pain represents a frequent symptom for referral to emergency departments and/or internal medicine outpatient setting. Similarly, fever, fatigue and weight loss are non-specific manifestations of disease. The present case describes the diagnostic process in a patient with abdominal pain and a palpable abdominal mass. Abdominal ultrasonography confirmed the presence of a mass in the mesogastrium. Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) scans oriented toward calcific lymphadenopathies with increased metabolism in the positron emission tomography-computed tomography (PET-CT) scan. Laboratory examinations were inconclusive, although serology for Brucella and the Quantiferon test were positive. After multidisciplinary discussion, the patient underwent surgical excision of the abdominal mass. Histological examination excluded malignancies and oriented toward brucellosis in a patient with latent tuberculosis. The patient was treated with rifampin 600 mg qd and doxycycline 100 mg bid for 6 weeks with resolution of the symptoms. In addition, rifampin was continued for a total of 6 months in order to treat latent tuberculosis. This case underlines the need for a multidisciplinary approach in the diagnostic approach to abdominal lymphadenopathies.