Infected Total Knee Arthroplasty by Brucella melitensis: A Rare Case Report

Introduction: Brucellosis is a zoonotic infectious disease with worldwide distribution, especially in the south and central American countries, the Middle-East and the Mediterranean areas. Knee prosthesis infection due to Brucella spp. is very rare with the first case reported in 1991 and the ninth case reported in 2010. Case Presentation: Here is reported a case of a 68-year-old female patient, referring to Shafa Orthopedic hospital, Tehran, Iran, complaining about a discharge from right total knee arthroplasty. All of the knee joint aspirations and laboratory tests were negative for infection. Initially, no clear reason was found for this painful operated knee and it was decided to revise it; however, intraoperative samples were positive for Brucella melitensis. Unfortunately, serum indicators of Brucellosis (Wright, Coombs Wright and 2-mercaptoethanol (2ME) tests) had not been checked in the preoperative evaluations. After six months of antibiotic therapy for brucellosis, a second stage revision surgery was performed successfully. Conclusions: Prosthetic infection byBrucella species is very uncommon, this is the tenth case of total knee prosthesis infection with Brucella spp. reported in the literature but all orthopedic surgeons, especially those who work in the endemic areas, should evaluate a suspected joint for brucellosis.