Case Presentation: We describe a 49-year-old Latino male treated for Brucellosis infection due to Brucella melitensis (B. melitensis). The patient presented to the emergency department (ED) with 2-weeks of fevers, night sweats, 27lb weight loss, nausea, and diarrhea. In the ED, the patient had a fever of 102.2F, tachycardia (97bpm), moderate hyponatremia (128), hypokalemia (2.8), hypoalbuminemia (3.0), mildly elevated AST (109) and ALT (82), leukopenia (2.6), anemia (8.3) and a CT abdomen and pelvis showed splenomegaly. Given these abnormalities, the patient was admitted to general medicine service for further evaluation (autoimmune, infectious, malignancy workups) and supportive care. The infectious disease team was consulted, and the patient disclosed that he had visited Mexico 2 months prior and had consumed an unpasteurized goat cheese and its whey in a sauce. This made Brucellosis the leading etiology of patient’s clinical presentation. While awaiting confirmation, the patient continued to experience high fevers, developed pancytopenia and worsening liver dysfunction. On day 4, 3 out of 4 blood cultures grew a gram negative coccobacili (later confirmed as B. Melitensis), and the patient was started on oral doxycycline and rifampin, which he took for 6 weeks. The patient had clinical improvement in symptoms, liver function and blood cell counts upon outpatient follow up.
Discussion: Brucellosis is a reportable zoonotic disease in the world and is caused by 4 species, B. abortus, B. melitensis, B. suis and B. canis. It is mostly endemic to the Mediterranean, Arabian Gulf, Central Asia, and parts of Latin America. Brucellae are intracellular gram-negative aerobic coccobacilli that can disseminate to multiple organs and systems. Brucella species is considered a bioterrorism agent since it has a low infectious dose (10–100 Brucella organisms), and its incubation period ranges from 5 days-6 months. Most people get infected by close contact with infected animals such as livestock, game animals, cats or dogs or consumption of infected animal products such uncooked meat or unpasteurized milk products. This patient’s clinical presentation is similar to the typical presentation of Brucellosis, which includes fevers, arthralgias, myalgias, malaise, night sweats, abdominal pain, and weights loss along with hepatomegaly, splenomegaly, liver dysfunction and electrolyte abnormalities. B. melitensis accounts for up to 73% of brucellosis cases and is usually acquired by eating unpasteurized milk products. In the USA, most cases due to B. Melitensis infections have been found in Latinx patients that have traveled to or from Mexico and have consumed unpasteurized milk products. Therefore, this patient was at high risk for developing Brucellosis due to B. Meltensis since he travelled to Mexico and had consumed unpasteurized goat cheese and its whey.
Conclusions: This case of Brucellosis highlights the importance of obtaining a thorough travel and exposure history to detect and treat immediately rare and serious infections such as Brucellosis. This also highlights the importance of providing health education to the public and patients about taking precautions when travelling to endemic areas of Brucellosis.