The Indian Journal of Chest Diseases and Allied Sciences

Register      Login

VOLUME 62 , ISSUE 3 ( July-September, 2020 ) > List of Articles

CASE REPORT

An Unusual Cause of Non-Resolving Pneumonia–Brucellosis

Pavirala Saitej, Govindaraj Vishnukanth, Archana Mallick, Saka Vinodkumar

Keywords : Brucellosis, Pneumonia, Non-Resolving, Miliary pattern

Citation Information : Saitej P, Vishnukanth G, Mallick A, Vinodkumar S. An Unusual Cause of Non-Resolving Pneumonia–Brucellosis. Indian J Chest Dis Allied Sci 2020; 62 (3):149-152.

DOI: 10.5005/ijcdas-62-3-149

License: CC BY-NC 4.0

Published Online: 07-11-2022

Copyright Statement:  Copyright © 2020; The Author(s).


Abstract

A 76-year-old male, cotton mill worker by occupation, “never smoker”, reported to us with complaints of fever, dry cough, breathlessness, loss of weight and loss of appetite of one month duration. He had no other co-morbid illness. He was evaluated elsewhere and on the basis of clinical presentation and chest radiographic findings, he was started on Category I therapy under Directly Observed Treatment, short-course (DOTS) for possibile miliary tuberculosis (TB). After three weeks of anti-TB treatment, patient came to our department with increasing breathlessness, persistent fever and cough. Physical examination revealed fever, low oxygen saturation on pulse oximetry, bilateral crepitations in the chest and hepatomegaly. High resolution computed tomography (HRCT) of the chest showed bilateral nodular opacities with few reticular shadows involving all the lobes Serological testing for rickettsia and dengue was negative. Fibreoptic bronchoscopy was performed and testing of bronchial washings for bacteria, fungi, Mycobacterium tuberculosis were all negative. He gave history of consuming raw milk for many years. Liver biopsy showed granulomatous hepatitis. Standard agglutination test for Brucella antibody was positive, and the patient was treated with oral rifampicin and doxycycline for six weeks. Patient had clinical improvement within two weeks of therapy. A repeat chest radiograph and CT at four weeks showed near total resolution of the shadows. We document this case with miliary pattern as an uncommon manifestation of brucellosis. The present case highlights the fact that, in endemic areas, brucellosis should be considered in the differential diagnosis of pulmonary diseases, especially when there is a history of consumption of raw milk.


PDF Share
  1. Vigeant P, Mendelson J, Miller M. Human to human tranmission of Brucella melitensis. Canadian J Infect Dis 1995;6:153–5.
  2. Smits HL, Kadri SM. Brucellosis in India: a deceptive infectious disease. Indian J Med Res 2005;5:375–4.
  3. Agasthya AS, Isloor S, Prabhudas K. Brucellosis in high risk group individuals. Indian J Med Microbiol 2007;1:28–31.
  4. Mantur BG, Amarnath SK. Brucellosis in India: a review. J Biosci 2008;4:539–7.
  5. Pappas G, Bosilkovski M, Akritidis N, Mastora M, Krteva L, Tsianos E. Brucellosis and the respiratory system. Clin Infect Dis 2003;37:95–9.
  6. Uluð M, Can-Uluð N. Pulmonary involvement in brucellosis. Canadian J Infect Dis Med Microbiol 2012;23:13–5.
  7. Simsek F, Yildirmak MT, Gedik H, Kantürk A, Iris EN. Pulmonary involvement of brucellosis: a report of six cases. African Health Sci 2011;11:112–6.
  8. Dikensoy O, Namiduru M, Hocaoglu S, Ikidag B, Filiz A. Increased pleural fluid adenosine deaminase in brucellosis is difficult to differentiate from tuberculosis. Respiration 2002;69:556–9.
  9. Kerem E, Diav O, Navon P, Branski D. Pleural fluid characteristics in pulmonary brucellosis. Thorax 1994;49:89–90.
  10. Gattas N, Loberant N, Rimon D. Miliary and reticulonodular pulmonary brucellosis. Harefuah 1998;135:357–9.
  11. Solera J, Beato JL, Martínez-Alfaro E, Segura JC, de Tomas E. Azithromycin and gentamicin therapy for the treatment of humans with brucellosis. Clin Infect Dis 2001;32:506–9.
  12. Singh M, Salaria M, Kumar L. Pneumonic presentation of brucellosis. Indian J Pediatr 2005;72: 65–6.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.