Brucellosis Complicated with Pulmonary Thromboembolism - Case Report

Pulmonary involvement is a rare manifestation of brucellosis which occurs by inhalation of infected aerosol or by hematogenous spreading. Pulmonary manifestations, including pleural effusions and pneumonias, can be found in up to 16% of complicated cases of brucellosis. A case report of complicated brucellosis is presented. A male patient aged 30, smoker, a cattle-breeder who lives in a countryside, was admitted to the Clinic for Infectious Diseases. He complained for 3 months about fever, night sweating, pain in ankles and lumbar spine, fatigue, weight loss, non-productive cough. Physical examination revealed auscultatory in the lower part of the right hemithorax, weakened to silent breath sound, liver and spleen palpable 1 to 2 cm, ankles mildly swollen, without redness. Blood tests revealed elevated CRP, ESR, fibrinogen and transaminases, mild leucopenia and anaemia. Diagnosis was proved by serological tests and positive blood cultures. As chest X-ray was suspicious for pleural effusion, chest CT and ventilation/perfusion lung scan were performed and showed pulmonary thromboembolism (PTE) presented in approximately 11%. Approximately 800 ccm of serous exudate was evacuated by thoracocenthesis. Radiological examination showed no osteoarticular involvements despite clinical signs of lumbosacral syndrome. He was treated with prolonged causal therapy combined with anticoagulant and symptomatic/supportive therapy and responded well, with improvement. Literature data lacked reports on brucellosis complicated with PTE without objective risk factors. Relevant immunological tests performed implie infection triggered immunological processes leading to PTE.