Skip to main content

Advertisement

SpringerLink
Log in

Abnormal liver findings as the first manifestation in a patient with brucellosis

Case report

Erhöhte Leberwerte als Erstmanifestation einer Brucellose

Fallbericht

  • case report
  • Published:
Wiener Medizinische Wochenschrift Aims and scope Submit manuscript

Summary

In January 2019, a 30-year-old woman admitted to our inpatient department presented with undulating fever, pain in several joints, and significantly elevated liver enzymes and lactate dehydrogenase. After extended examination, infection with Brucella melitensis with liver, musculoskeletal, and pulmonary involvement was diagnosed and treated. Diagnosis was based on clinical examination, laboratory findings including seroconversion as a proof of immune response, magnetic resonance imaging, three-phase bone scintigraphy, and F‑18 FDG-PET (F-18 Flourdeoxyglucose positron emission tomography) illustrating the bone involvement and its normalization upon treatment. After treatment the patient showed a remarkable improvement of clinical symptoms within a short period. The patient remained symptom free and polymerase chain reaction (PCR) testing for brucellosis was negative, even at the follow-up examination 12 months after the end of the antibiotic therapy. The family members were also examined due to the similar travel history, and by this, brucellosis was also diagnosed in her husband but not in her children.

Zusammenfassung

Bei einer 30-jährigen Patientin mit undulierendem Fieber und Schmerzen in mehreren Gelenken wurde im Januar 2019 eine massive Erhöhung der Leberwerte und der Laktatdehydrogenase festgestellt. Eine umfassende laborchemische und bildgebende Diagnostik inklusive Magnetresonanztomographie, Knochenszintigraphie und 18F‑Fluordesoxyglukose-Positronenemissionstomographie (18F‑FDG-PET) erbrachte als Ursache für die Beschwerden der Patientin eine Infektion mit Brucella melitensis mit Leber‑, Gelenk- und Lungenbeteiligung. Die Kontrolle des Behandlungserfolgs erfolgte anhand des klinischen Bildes, der Laborbefunde inklusive Serokonversion als Zeichen für eine ausreichende Immunantwort sowie der Ergebnisse der Bildgebungsuntersuchungen, welche die Leber- und Knochenaffektion bzw. deren Rückbildung unter der Therapie zeigten. Schon kurz nach Beginn der Behandlung mit Antibiotika wies die Patientin eine deutliche Besserung des klinischen Bildes auf, nach mehreren Wochen Antibiotikatherapie gab die Patientin keine Beschwerden mehr an. Bei der Kontrolle 12 Monate nach Beendigung der Antibiose war die Patientin weiterhin beschwerdefrei und die Polymerasekettenreaktion (PCR) auf Brucellen war negativ. Die Untersuchung der Familienmitglieder wegen der gleichen Reiseanamnese ergab negative Ergebnisse auf Brucellose bei den beiden Kindern, jedoch beim Gatten der Patientin eine Brucellose, die nachfolgend ebenfalls antibiotisch therapiert wurde.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Dean AS, Crump L, Greter H, et al. Global burden of human brucellosis: a systematic review of disease frequency. PLoS Negl Trop Dis. 2012;6:e1865.

    Article  Google Scholar 

  2. Seedat J. Reiseassoziierte Infektionskrankheiten. Epidemiol Bull. 2019;48:517.

    Google Scholar 

  3. Much P, Arrouas M, Herzog U. Zoonosen und ihre Erreger in Österreich. Bericht 2018. Vienna: AGES; 2019. p. 56.

    Google Scholar 

  4. Gutierrez Ruiz C, Miranda JJ, Pappas G. A 26-year-old man with sternoclavicular arthritis. PLoS Med. 2006;3(8):e293.

    Article  Google Scholar 

  5. El-Sayed A, Awad W. Brucellosis: evolution and expected come back. Int J Vet Sci Med. 2018;6(Suppl):31–5.

    Article  CAS  Google Scholar 

  6. Selbitz HJ, Moos M. Tierärztliche Impfpraxis. 3rd ed. Stuttgart: Enke; 2006. p. 82.

    Google Scholar 

  7. Gilman HL, Dahlberg AC, Marquardt JC. The occurrence and survival of Brucella abortus in Cheddar and Limburger cheese. J Dairy Sci. 1946;9(2):71–85.

    Article  Google Scholar 

  8. Tuon FF, Gondolfo RB, Cerchiari N. Human-to-human transmission of Brucella—A systematic review. Trop Med Int Health. 2017;22(5):539–46.

    Article  Google Scholar 

  9. Pal M, Gizaw F, Fekadu G, et al. Public health and economic importance of bovine brucellosis: an overview. Am J Epidemiol Infect Dis. 2017;5(2):27–34.

    Google Scholar 

  10. Hull NC, Schumaker BA. Comparison of brucellosis between human and veterinary medicine. Infect Ecol Epidemiol. 2018;8(1):1500846.

    PubMed  PubMed Central  Google Scholar 

  11. Young DA. Florence Nightingale’s fever. BMJ. 1995;311(7021):1698.

    Article  Google Scholar 

  12. Corbel MJ. Brucellosis in humans and animals. Geneva: WHO; 2006. pp. 4–10.

    Google Scholar 

  13. Roushan MRH, Marashi SMA, Moulana Z. Polymerase chain reaction–based assays for the diagnosis of active and relapsed cases of human brucellosis. Am J Trop Med Hyg. 2016;95(6):1272–6.

    Article  Google Scholar 

  14. Colmenero JD, Reguera JM, Fernández-Nebro A, et al. Osteoarticular complications of brucellosis. Ann Rheum Dis. 1991;50(1):23–6.

    Article  CAS  Google Scholar 

  15. Ariza J, Bosilkovski M, Cascio A, et al. Perspectives for the treatment of brucellosis in the 21st century: the Ioannina recommendations. PLoS Med. 2007;4(12):e317.

    Article  Google Scholar 

  16. Turan H, Serefhanoglu K, Karadeli E, et al. Osteoarticular involvement among 202 brucellosis cases identified in central Anatolia region of Turkey. Intern Med. 2011;50(5):421–8.

    Article  Google Scholar 

  17. Arriola Benitez PC, Pesce Viglietti AI, Herrmann CK, et al. Brucella abortus promotes a fibrotic phenotype in hepatic stellate cells, with concomitant activation of the autophagy pathway. Infect Immun. 2017;86(1):e00522–17.

    Article  Google Scholar 

  18. Giambartolomei GH, Delpino MV. Immunopathogenesis of hepatic brucellosis. Front Cell Infect Microbiol. 2019;9:423.

    Article  CAS  Google Scholar 

  19. Akritidis N, Tzivras M, Delladetsima I, et al. The liver in brucellosis. Clin Gastroenterol Hepatol. 2007;5(9):1109–12.

    Article  Google Scholar 

  20. Wang Y, Ke Y, Duan C, et al. A small non-coding RNA facilitates Brucella melitensis intracellular survival by regulating the expression of virulence factor. Int J Med Microbiol. 2019;309(3–4):225–31.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Dept. Internal Medicine 2, General Hospital Mistelbach-Gänserndorf, Liechtensteinstraße 67, 2130, Mistelbach, Austria

    Natalia Medvedeva, Sabrina Cristiana Lazaruc & Peter Mikosch MD

  2. Dept. Nuclear Medicine, Wilhelminenspital, Vienna, Austria

    Siroos Mirzaei

  3. University Hospital Vienna, University Teaching Unit, Vienna, Austria

    Peter Mikosch MD

Authors
  1. Natalia Medvedeva
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sabrina Cristiana Lazaruc
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Siroos Mirzaei
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Peter Mikosch MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

N. Medvedeva wrote the manuscript, collected all medical history, and managed the patient during her stay in hospital. S. Lazaruc composed the tables and picked the images, S. Mirzaei examined PET and triple-phase bone scan images. P. Mikosch managed the patient at the outpatient department, and reviewed and edited the manuscript.

Corresponding author

Correspondence to Peter Mikosch MD.

Ethics declarations

Conflict of interest

N. Medvedeva, S. Lazaruc, S. Mirzaei, and P. Mikosch declare that they have no competing interests.

Ethical standards

For this article no studies with human participants or animals were performed by any of the authors. For images or other information within the manuscript which identify patients, consent was obtained from them and/or their legal guardians.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Medvedeva, N., Lazaruc, S.C., Mirzaei, S. et al. Abnormal liver findings as the first manifestation in a patient with brucellosis. Wien Med Wochenschr 172, 274–279 (2022). https://doi.org/10.1007/s10354-021-00862-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10354-021-00862-6

Keywords

Schlüsselwörter

Search

Navigation