Necrotizing pancreatitis associated with acute brucellosis: A rare clinical observation

Brucellosis is a zoonotic infection that often presents as fever of unknown origin (FUO) with multisystem involvement. Pancreatic complications-particularly necrotizing pancreatitis-are extremely rare and can pose diagnostic and therapeutic challenges.

A 49-year-old woman, a medical professional with no comorbidities, presented with recurrent high-grade fever (39-40 °C), anorexia, and generalized weakness for seven days, along with a 2 kg weight loss over one month. Brucella IgM serology (enzyme immunoassay) was positive, and blood cultures (Vitek 2, automated) confirmed Brucella melitensis after seven days of incubation. She was treated with oral rifampicin 600 mg once daily and doxycycline 100 mg twice daily, leading to defervescence within 48 h. Two weeks later, she developed severe epigastric pain radiating to the back with vomiting. Laboratory investigations revealed elevated serum amylase (1324 U/L) and lipase (4280 U/L), and contrast-enhanced CT demonstrated intraparenchymal non-enhancing foci, peripancreatic fat stranding, and fluid collections-findings consistent with acute necrotizing pancreatitis. Common etiologies such as gallstones, alcohol, trauma, hypertriglyceridemia, and pancreatotoxic drug exposure were excluded. Rifampicin and doxycycline were temporarily withheld during evaluation and re-initiated after stabilization. She was managed conservatively with intravenous fluids, bowel rest, and analgesia, achieving gradual improvement. Follow-up ultrasonography at six weeks showed complete radiological resolution of pancreas.

Necrotizing pancreatitis may rarely occur in association with acute brucellosis; however, establishing a direct causal relationship can be challenging. This case underscores the importance of considering brucellosis as a differential diagnosis of pancreatitis in endemic regions when common causes are excluded.