IJCRR - Vol 05 Issue 16, August, 2013
A COMPLICATED BANG’S DISEASE - CASE REPORT
Author: Sunny D.A.N., Amirtha B.G., Tevethia H.V., Kadavanu T., Panchbhaya R., Siva P.K., Somasundsaram S.
An uncommon organism or IE at an uncommon site is sufficient to create a diagnostic concondrum. Since its signs and symptoms are nonspecific, getting an absolute etiological diagnosis becomes a herculean task. A 45 year old man presented with fever, drenching sweats, right shoulder pain, low back ache and weight loss for 9 months. He gives history of travel to the middle east and was a gardener by occupation. H/O Ingestion of Unpasteurized milk was present. H/O rearing farm animals in middle east was present. Blood cultures were negative, 2D echo and Trans esophageal echo confirmed the presence of vegetations, So with the specific history IgM antibody for Brucella melitensis was done and showed positive. The titres showed 1:320. A Lumbosacral and Hip X-ray showed Sacroilitis. He was started on streptomycin and doxycycline. After 1 week he developed acute onset of breathlessness subsequently went to cardiogenic shock and was diagnosed to have rupture of sinus of valsalva and acute aortic regurgitation. He was immediately taken up for surgery for valve replacement. He is doing well on subsequent post operative follow ups. The purpose of presenting this case report is that, brucellosis is very rare and is an even rarer cause of endocarditis in our country. It also signifies the importance of detailed history taking in terms of travel and occupational history. Brucella accounts for 2% of all IE cases. We here present a case diagnosed as brucella endocarditis, who had later landed up in complications.
Keywords: Brucellosis, Endocarditis
Sunny D.A.N., Amirtha B.G., Tevethia H.V., Kadavanu T., Panchbhaya R., Siva P.K., Somasundsaram S.. A COMPLICATED BANG’S DISEASE - CASE REPORT International Journal of Current Research and Review. Vol 05 Issue 16, August, 35-37
1. Capasso L. Bacteria in two-millennia-old cheese, and related epizoonoses in Roman populations. J Infect 2002;45:122-127
2. Mylonakis E, Calderwood SB. Infective endocarditis in adults. N Engl J Med2001;345:1318-1330
3. Refai M. Incidence and control of brucellosis in the Near East region. Vet Microbiol 2002;90:81-110
4. Bouaziz MC, Ladeb MF, Chakroun M, Chaabane S. Spinal brucellosis: a review. Skeletal Radiol2008;37:785-790
5. Bosilkovski M, Krteva L, Caparoska S, Dimzova M. Hip arthritis in brucellosis: a study of 33 cases in the Republic of Macedonia (FYROM). Int J Clin Pract 2004;58:1023-1027
6. Ariza J, Pujol M, Valverde J, et al. Brucellar sacroiliitis: findings in 63 episodes and current relevance. Clin Infect Dis 1993;16:761-765
7. Reguera JM, Alarcon A, Miralles F, Pachon J, Juarez C, Colmenero JD. Brucella endocarditis: clinical, diagnostic, and therapeutic approach. Eur J Clin Microbiol Infect Dis 2003;22:647-650
8. Solera J, Martinez-Alfaro E, Saez L. Metaanalysis of the efficacy of rifampicin and doxycycline in the treatment of human brucellosis.Med Clin (Barc) 1994;102:731-738
9. Probert WS, Schrader KN, Khuong NY, Bystrom SL, Graves MH. Real-time multiplex PCR assay for detection of Brucella spp, B. abortu s and B. melitensis. J Clin Microbiol 2004; 42 :1290-3.
10. World Health organization; Fact sheet N173. World Health Organization: Geneva; 1997.