unusual clinical presentations of brucellosis
TRANSCRIPT
LETTER TO THE EDITOR
Unusual clinical presentations of brucellosis
OZLEM TURKSOY1, HUSNU TOKGOZ2 & SEMA TOPARLI1
From the 1Department of Radiology, Ankara Numune Training and Research Hospital, and 2Department of Urology, Ankara
Cankaya Hospital, Ankara, Turkey
Sir,
We read the article by Dr. Hatipoglu et al. with
interest (Scand J Infect Dis 2004; 36:694�/7). The
authors reported 11 cases with atypical presentations
of brucellosis among 240 patients with systemic
brucellosis. They observed 10 patients with neuro-
brucellosis, peritonitis, pericarditis, pancytopenia,
uveitis and 1 patient with epididymo-orchitis. We
have experienced a similar case with brucella epidi-
dymo-orchitis. A 58-y-old male patient was admitted
to emergency service with complaints of fever,
headache, fatigue for 3 months and right scrotal
swelling and mass lesion for 15 d. Brucella tube
agglutination titer was 1/1280 and scrotal examina-
tion revealed minimally tender and very swollen right
hemiscrotum. On scrotal ultrasonographic examina-
tion (GE Logic-9), multiple hypoechoic solid nod-
ular lesions, some of which were necrotic-cystic
centrally in the testis parenchyma, were noticed.
The right epididymis was multiloculated and cystic
in nature with thickening of the wall. The patient
was hospitalized with a presumptive diagnosis of
brucellosis and right epididymo-orchitis. Antibiotic
treatment with streptomycin (1 g/d i.m.) for 3 weeks
and tetracycline (2�/100 mg/d p.o.) for 6 weeks was
given. At the follow-up examination 6 weeks later, all
the symptoms had resolved and scrotal ultrasono-
graphy was normal. Unfortunately, no bacteria were
isolated from blood and urine cultures. Amin et al.
reported the use of polymerase chain reaction (PCR)
for detection of Brucella melitensis in semen [1]. In
addition, Vandercam et al. have isolated Brucella
melitensis from human sperm [2]. However, no
semen samples were obtained from our patient.
Finally, we would like to mention that accurate
diagnosis with appropriate antibiotics prevents ex-
cessive medication and unnecessary surgical inguinal
exploration for the testis involved in cases of
epididymo-orchitis caused by infectious agents
such as Brucella.
We thank Dr. Hatipoglu and her associates for this
interesting and insightful article.
References
[1] Amin AS, Hamdy ME, Ibrahim AK. Detection of Brucella
melitensis in semen using the polymerase chain reaction assay.
Vet Microbiol 2001;/83:/37�/44.
[2] Vandercam B, Zech F, de Cooman S, Bughin C, Gigi J,
Wauters G. Isolation of Brucella melitensis from human
sperm. Eur J Clin Microbiol Infect Dis 1990;/9:/303�/4.
Correspondence: H Tokgoz, Cukuranbar Mah. 41. Cad., No. 2/35 Balgat, Ankara, Turkey. Tel: �/90 312 4261450. Fax: �/90 312 4679706. E-mail:
Scandinavian Journal of Infectious Diseases, 2005; 37: 784
(Received 17 April 2005; accepted 26 April 2005)
ISSN 0036-5548 print/ISSN 1651-1980 online # 2005 Taylor & Francis
DOI: 10.1080/00365540510044094
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