Pulmonary Brucellosis Case Report

Brucellosis, an endemic disease in our country, is a systemic disorder characterized with recurrent fever, joint pain, malaise and anorexia. Although it may affect many systems, respiratory involvement is quite rare. In case of respiratory system involvement, the most common (10-33%) symptom is non-productive cough. Our patient was a 76 year old male living in rural areas engaged in farming. He was hospitalized with fifteen days ongoing complaints, dry cough, fever with chills and tendency to sleep. On physical examination, fever, tachypnea, decreased breath sounds at left lung baseline and crepitan crackles at right baseline and loss of muscle strength was present. In his history, fresh cheese consumption was present. Empirically, ceftriaxone and clindamycin was initiated. Brucella agglutination was 1/160 titer positive. Doxycycline and rifampin was started. Thoracic computed tomography revealed pneumonia and minimal pleural effusion on the left lobe. The other pneumonia agents were excluded serologically. Cerebrospinal fluid revealed normal findings. Neurobrucellosis was excluded. On the fifth day of brucellosis treatment patient was afebrile, general condition improved and lung symptomsand findings resolved. Blood culture was positive for Brucella melitensis. The patient completed 8 weeks of treatment, clinical and radiological improvement was seen. Brucellosis, an endemic disease in our country, rarely shows pulmonary involvement and it should be kept in mind in differential diagnosis in patients admitted with pneumonia.

Pulmoner Bruselloz Olgu Sunumu

Bruselloz; ülkemizde endemik olarak görülen, tekrarlayan ateþ, eklem aðrýsý, halsizlik, iþtahsýzlýk ile seyreden sistemik bir hastalýktýr. Solunum sistemi tutulumunda en sýk görülen semptom %10-33 ile non prodüktif öksürüktür. Olgumuz, 76 yaþýnda, erkek hasta kýrsal bölgede çiftçilik ile uðraþýyor. On beþ gündür devam eden kuru öksürük, üþüme-titreme ile yükselen ateþ ve uykuya eðilim þikayetleri ile enfeksiyon hastalýklarý servisine yatýþý yapýldý. Özgeçmiþinde taze peynir tüketimi mevcuttu. Hastaya ampirik sefrtriakson 2x2 gr ve klindamisin 4x600 mg IV baþlandý. Brusella agglutinasyonu 1/160 titrede pozitif olarak saptandý. Doksisiklin 2x100 mg ve rifampisin 2x300 mg baþlandý. Toraks bilgisayarlý tomografisinde (BT) pnömoni, solda minimal plevral efüzyon izlendi. Pnömoni etkenleri serolojik olarak dýþlandý. Bruselloz tedavisinin 5. gününde hastanýn ateþi düþtü, genel durumu düzeldi ve akciðer dinleme bulgularýnda düzelme görüldü. Kan kültüründe Brucella melitensis üremesi oldu. Tedavisi 8 haftaya tamamlanan hastada klinik ve radyolojik olarak düzelme görüldü. Ülkemizde endemik olarak görülen brusellozun nadir görülen pulmoner tutulumu, pnömoni ile baþvuran hastalarda ayýrýcý tanýda akýlda tutulmalýdýr.