Brucella septic arthritis: A case series and review of the literature

Brucellosis is a zoonotic infection with a significant global health impact, particularly in endemic regions such as Saudi Arabia. Osteoarticular involvement is one of the most common complications, with septic arthritis representing a challenging clinical entity that requires prompt diagnosis and appropriate management.

We conducted a retrospective analysis of 18 patients with culture-confirmed Brucella septic arthritis treated at three hospitals in Saudi Arabia. Patient demographics, clinical presentations, laboratory findings, imaging results, treatment regimens, surgical interventions, and outcomes were analysed. A comprehensive literature review was performed to contextualize our findings within the current evidence.

The case series predominantly included males (67 %), with a mean age of 59.5 years, and the knee was the most frequently affected joint (78 %). All patients presented with joint pain; most had swelling (88 %) and a limited range of motion (94 %), while fever was present in only 59 % of cases. Laboratory findings typically showed elevated inflammatory markers, along with normal white blood cell counts, in most patients. All patients received combination antibiotic therapy (usually three), most commonly doxycycline, rifampin, and an aminoglycoside, for a median duration of 105 days. Surgical intervention was performed in 47 % of cases. All patients achieved clinical improvement, though 61 % experienced residual joint dysfunction. No relapses were observed during the study's follow-up period.

Brucella septic arthritis exhibits unique clinical and laboratory characteristics that are distinct from those of other bacterial arthritis. While extended combination antibiotic therapy remains effective, residual joint dysfunction is frequently observed, highlighting the need for comprehensive post-treatment care. Early recognition is essential for prompt diagnosis in patients from endemic regions presenting with monoarticular arthritis, as they may lack systemic symptoms, necessitating a high index of clinical suspicion.