Multiple abscesses in brucellosis with Wright's test negativity

Area of Science:

• Infectious Diseases
• Internal Medicine
• Pathology

Background:

• Brucellosis is a zoonotic bacterial infection that can cause severe systemic complications.
• Chronic brucellosis may present with atypical manifestations, including metastatic abscess formation.
• Diagnostic challenges exist, especially when initial tests are negative.

Purpose of the Study:

• To report a rare case of metastatic abscesses secondary to chronic brucellosis.
• To highlight diagnostic difficulties and the importance of serological testing in suspected brucellosis.
• To underscore the potential severity and fatal outcomes of untreated or inadequately managed brucellosis.

Main Methods:

• Case report of a shepherd with cachexia and signs of inflammation.
• Diagnostic imaging including abdominal computed tomography (CT) scan.
• Laboratory investigations: blood cultures, tuberculin skin test, Wright reaction, and Brucella Coombs test.
• Serological testing for anti-Brucella IgM antibodies.

Main Results:

• Abdominal CT revealed multiple hepatic and renal abscesses and an abdominal wall fluid mass.
• Initial tests (blood cultures, skin test, Wright reaction) were negative.
• Brucella Coombs test was highly positive, confirming the diagnosis.
• High titre of anti-Brucella IgM antibodies further supported the diagnosis.

Conclusions:

• Chronic brucellosis can manifest as widespread metastatic abscesses.
• The Brucella Coombs test and specific antibody titres are crucial for diagnosis when other methods fail.
• Prompt antibiotic treatment is essential, but long-term follow-up is critical for patient outcomes.
• This case emphasizes the potential for severe morbidity and mortality in brucellosis.