Management of Pleural Brucellosis: Case Report

Adel Alothman1,2, Salih Bin Salih1,2, Salwa Alothman2 and Ghassan Al Johani21College of Medicine, KSAU-HS. 2Department of Medicine, KAMC-Riyadh, SA.AbstractBackground: Brucellosis is a zoonotic disease, with low incidence rate in developed countries, however the incidence rate in Middle Eastern countries remains high. Chest symptoms in brucellosis cases account for about 15% of the cases, but dealing with respiratory system involvement is rare particularly pleural involvement.Case Report: We report a case of a 60-year-old Saudi woman who was admitted with two months history of fever, productive cough, anorexia and weight loss, contact with sheep. She was ill looking, underweight and febrile while she was on treatment. Examination of the chest showed signs of pleural effusion on the right side with right infrascapular crepitations. Chest X-ray: showed pleural effusion and right LL infiltrates. CT chest: showed right loculated, pleural effusion. Pleural fluid examination showed exudative changes, on culture of pleural fluid, Brucella species grew. AFB in pleural fluid was negative. She was treated with Streptomycin, Doxycyclin and Ciprofloxacin . She improved within one week of treatment and was discharged, after 14 days on antibrucella therapy.Discussion: Pulmonary brucellosis is reported in medical literature occasionally but only few reports are available about pleural brucellosis. The challenge with pleural brucellosis and the association of loculated abscesses lies in therapy. Due to lack of previous information with such cases, we suggest that a period of more than six weeks is needed to treat this condition. We recommend that pleural brucellosis needs to be treated with at least two therapeutic agents for nine weeks.