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CASE REPORT
Brucella endocarditis in a non-endemic area presenting as pyrexia of unknown origin
  1. Vivek Vilas Manade1,
  2. Arjun Kakrani1,
  3. Siddharth Narayan Gadage1,
  4. Rabindra Misra2
  1. 1Department of Medicine, Padmashree Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India
  2. 2Department of Microbiology, Padmashree Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India
  1. Correspondence to Dr Vivek Vilas Manade, dr.vivek.manade7{at}gmail.com

Summary

A 67-year-old man with type 2 diabetes mellitus and hypertension since 7 years presented with a 3-month history of low-grade fever and malaise. Cardiac auscultation revealed the presence of an ejection systolic murmur in the primary aortic area. Most of the investigations for febrile illness were reported normal. His two-dimensional (2D) echocardiogram revealed a calcified aortic valve with mild aortic stenosis. In view of the prolonged fever and calcified aortic valve with mild aortic stenosis, a transoesophageal echocardiogram was performed, which showed small vegetation noted on right coronary cusp about 2.2 mm with free independent mobility. Blood culture was positive for Brucella spp from all the three venepuncture sites. Medical therapy for brucellosis was given with ciprofloxacin, doxycycline, co-trimoxazole and streptomycin, resulting in complete recovery. Brucella endocarditis is a rare, mostly ignored and missed clinical infection. It requires a high index of clinical suspicion for prompt diagnosis and treatment.

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