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


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).


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.

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