Case report 875: Multifocal osteomyelitis--a manifestation of chronic brucellosis

A 62-year-old man who had had chronic brucellosis for at least 14 years, presumably caused by ingestion of unpasteurized milk, presented with recurrent, multifocal osteomyelitis involving both tibias and a humerus, which had a pathologic fracture. Radiographs showed a large destructive lesion in the humeral diaphysis with a pathologic fracture and multiloculated radiolucencies, together with sclerotic zones in multiple long bones. Histologically, necrotizing, granulomatous inflammatory changes were compatible with a diagnosis of osteomyelitis. Bone biopsy cultures and agglutination titers were positive for Brucella abortus. The case represents an uncommon manifestation of Brucella infection which is particularly rare in the United States. A proper clinical examination should lead to consideration of the diagnosis.