Pulmonary Brucellosis In A Patient With Prolonged Dyspnea And Cough

1. Abstract Brucellosis is a bacterial endemic zoonotic disease of global significance with detrimental impacts on public health and food animal production. It is caused by Brucella spp., an expanding group of pathogens able to infect various host species. Bovines and small ruminants, which excrete the bacteria in milk and in reproductive discharges, are major sources of infection for humans and other animals. Contact with contaminated animals and consumption of unpasteurized dairy products are the main routes for human infection [1]. Pulmonary symptoms are rare in Brusellosis and pulmonary involvement is uncommon and nonspecific. Dyspnea, cough, sputum, and flu-like syndrome, night sweats and low back pain are the most common symptoms in pulmonary involvement of brucellosis [2].

2. Case Report Our case is a 55 years old women with dyspnea, cough and prolonged fever from 6 months ago. She also mentioned night sweats. At the first time, in cardiac evaluation, she referred to the cardiology hospital because of cardiomegaly and moderate to severe pericardial effusion and received medical treatment with low dose of prednisolone (5mg) and colchicine (1mg/d) but her dyspnea was remained stable. So, after evaluation and exclusion of other cardiac disease, she referred to pulmonary cilinician for pulmonary thromboembolism because of dyspnea and at rest desaturation. Pulmonary thromboembolism was excluded by pulmonary CT angiography and then she referred to pulmonary ward for checking tuberculosis because of CT scan abnormality and consulidation in Right lower lobe.(figure 1) Bronchoscopy was performed for the patient twice.

3. Discussion The most common and virulent species of Brucella that infect human are Brucella melitensis and Brucella abortus. Human brucellosis generally occurs through direct exposure to the pathogen [3]. Our patient had direct contact with dairy products before the onset of the symptoms. Any organ may be affected. The onset of symptoms may be acute or insidious and they are nonspecific. There are few reports of respiratory symptoms and lung disease in patients with brucellosis. The clinical manifestation of our patient were consistent with lower respiratory infection and it was justified by imaging findings. Tuberculosis, tumors and granulomatous disease should be considered in the differential diagnosis.

4. Conclusion Brucellosis is a systemic infection that has nonspecific signs and symptoms. We should keep in the mind that brucellosis is a good diagnosis in any patient with personal history of exposure to a possible source of infection.

References 1. Bagheri Nejad R, Krecek RC, Khalaf OH, Hailat N, Arenas-Gamboa AM. Brucellosis in the Middle East: Current situation and a pathway forward. PLoSNegl Trop Dis. 2020;14(5):e0008071.

2. Akkoyunlu ME, Akkoyunlu Y, Hakyemez IN, Erboy F. Pulmonary brucellosis detected during treatment of active tuberculosis in a patient with operated lung cancer (Case report). European Respiratory Journal. 2012;40(Suppl 56):P577.

3. Simsek F, Yildirmak MT, Gedik H, Kantürk A, Iris EN. Pulmonary involvement of Brucellosis: a report of six cases. Afr Health Sci. 2011;11 Suppl 1:S112-6.

Marzieh Hashemi. Pulmonary Brucellosis In A Patient With Prolonged Dyspnea And Cough. Annals of Clinical and Medical Case Reports 2024