A 43-year-old woman rural dweller working in animal husbandry presented with high fever, chills, nausea, and vomiting. She was diagnosed with brucellosis based on the Brucella standard tube agglutination test and blood culture results. Due to persistent vomiting, she was treated with intravenous tigecycline and oral gentamicin and rifampicin therapy. However, despite appropriate antimicrobial treatment, a clinical and laboratory response was not achieved. The course of inflammation indicators during treatment is shown in Figure 1. Right lower quadrant tenderness was noted on abdominal examination. Magnetic resonance imaging revealed a 12-cm cyst in the region of the right ovary, which was suspected to be a mature cystic teratoma (Figure 2). We performed right ovariectomy and cystectomy (Figure 3). The patient’s fever, nausea, and vomiting resolved from postoperative day 2. İntraoperative cultures of samples of the teratoma yielded Brucella spp. The patient's treatment was switched to rifampicin and doxycycline 2 weeks postoperatively and was discontinued after 8 weeks. Treatment failure in brucellosis is defined as the persistence of disease signs and/or symptoms after the initiation of appropriate antimicrobial therapy11. Solís García del Pozo J, Solera J. Systematic review and meta-analysis of randomized clinical trials in the treatment of human brucellosis. PLoS One. 2012;7(2) e32090.. The most common complications of brucellosis are osteoarticular and genitourinary involvement22. Ozger HS, Karasahin O, Yildiz Y and Dizbay M. Osteoarticular Involvement and Inadequate Treatment of Brucellosis are Related to Relapse. Mediterranean Journal of Infection, Microbes & Antimicrobials. 2020;9(1):NA- NA. Considering the potential of Brucella to invade several tissues, this case illustrates the importance of genitourinary system evaluation in the event of treatment failure33. Uwaydah M, Khalil A, Shamsuddine N, Matar F and Araj G. Brucella-infected ovarian dermoid cyst causing initial treatment failure in a patient with acute brucellosis. Infection 1998; 26: 131-132.. Furthermore, tigecycline may be an option for combination therapy in patients with severe brucellosis44. Dizbay M, Kilic S, Hizel K and Arman D. Tigecycline: its potential for treatment of brucellosis. Scand J Infect Dis. 2007; 39 (5): 432-434..
Mature ovarian cystic teratoma on T2-weighted axial (a) and sagittal (b) magnetic resonance imaging.
ACKNOWLEDGMENTS
We thank the nurses involved in the care of this case.
REFERENCES
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1Solís García del Pozo J, Solera J. Systematic review and meta-analysis of randomized clinical trials in the treatment of human brucellosis. PLoS One. 2012;7(2) e32090.
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2Ozger HS, Karasahin O, Yildiz Y and Dizbay M. Osteoarticular Involvement and Inadequate Treatment of Brucellosis are Related to Relapse. Mediterranean Journal of Infection, Microbes & Antimicrobials. 2020;9(1):NA- NA
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3Uwaydah M, Khalil A, Shamsuddine N, Matar F and Araj G. Brucella-infected ovarian dermoid cyst causing initial treatment failure in a patient with acute brucellosis. Infection 1998; 26: 131-132.
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4Dizbay M, Kilic S, Hizel K and Arman D. Tigecycline: its potential for treatment of brucellosis. Scand J Infect Dis. 2007; 39 (5): 432-434.
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Financial Support: None.
Publication Dates
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Publication in this collection
05 Feb 2024 -
Date of issue
2024
History
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Received
25 Oct 2023 -
Accepted
12 Dec 2023