BRUCELLA OSTEOMYELITIS IN A TRAVELER TO THE UNITED STATES

Document Type

Conference Proceeding

Publication Date

6-23-2023

Publication Title

J Gen Intern Med

Abstract

CASE: An 84-year-old male presented with a two-month history of intermittent fevers, malaise, weight loss, difficulty ambulating, and bowel and bladder incontinence. Before the onset of these symptoms, he had been independent in mobility with normal bowel and bladder function. On initial assessment, the patient had unremarkable vital signs and was afebrile. Examination was notable for tenderness over the lower lumbar spine with decreased strength, but normal sensation in the bilateral lower extremities. Workup was notable for a leukocytosis to 13.2 K/uL with elevated CRP 9.9 mg/dL and ESR 86 mm/ hr. Given the neurological findings, spinal MRI was performed and showed osteomyelitis at the C5-6 and L4-5 levels. CT-guided bone biopsy was obtained, and antibiotics were initiated with Vancomycin and Piperacillin-Tazobactam. Despite coverage with broad-spectrum antibiotics, the patient developed persistent fevers with a maximum temperature of 102.5 F. Blood and bone biopsy cultures later returned with concern for Brucella. Subsequent testing was remarkable for Brucella IgM of 1.56 and Brucella Antibody titer of 1:80, suggestive of active Brucella infection. Further elicitation of history noted that the patient was a shepherd in Yemen, where he had traveled from about 4 months ago; he had daily contact with sheep and cattle and would often consume unpasteurized milk. Given the diagnosis of Brucellosis, antibiotics were adjusted to Doxycycline and Rifampin, which he was treated with for six months. He had significant clinical improvement and followed up with Infectious Disease clinic. IMPACT/DISCUSSION: Brucellosis is a zoonotic infection with reservoirs typically including cattle, dogs, sheep, and goats. It is usually transmitted via ingestion of unpasteurized dairy products or undercooked meat from infected animals, inhalation of aerosols, and contact of broken skin or mucous membranes with animal tissues, bodily fluids, and placentas. At-risk populations include slaughterhouse workers, shepherds, and veterinarians. Brucellosis is rarely seen in the US, with 100-200 annual cases. Our case demonstrates the varying and often nonspecific presentation of Brucellosis, which can mimic other diseases, including osteomyelitis, tuberculosis, malignancy, and meningitis. Although Brucellosis is very rare in the US, it should be considered on the differential in patients presenting with fevers, back pain, and night sweats, especially in travelers. It also underlines the importance of thorough history taking, including travel and occupational history, as it can give clues to aid in diagnosis and management. CONCLUSION: -Recognize the importance of thorough history taking, including travel and occupational history, especially in patients presenting with infectious symptoms -Being aware of the signs and symptoms of Brucellosis, as well as general management -Although Brucellosis is rarely seen in the US, keeping it on the differential, especially in patients who have lived or recently traveled abroad.

Volume

38

Issue

Suppl 3

First Page

S435

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