Two rare cases of Brucella-induced endocarditis and myopericarditis: challenges in diagnosis

Abstract

Introduction: Brucellosis is one of the most common zoonotic infections in the world. Cardiac complications of the disease are usually in the form of endocarditis, and, to a lesser extent, in the form of myopericarditis.

Case: We report the case of a 34-year-old female admitted with signs of fever, nausea, and headache. The patient came from Libya, where she drank unpasteurized milk. Whright-Coombs test and blood confirmed Brucella species infection, while transoesophagal echocardiogram revealed a thrombotic mass on the tricuspid valve that required cardiac surgery and antibiotic treatment, leading to complete recovery. The second case was a 37-years-old male admitted with suspected acute coronary syndrome, where further diagnostics excluded occlusions of coronary arteries and found Brucella species infection and signs of myocardial and pericardial involvement that reacted well on treatment (combination of doxycycline and rifampicin).

Discussion: Brucellosis is commonly seen in people working with farm animals or using unpasteurized milk but is still often misdiagnosed.

Conclusions: Tricuspid valve endocarditis, as well as isolated myopericarditis, are rare complications of Brucellosis, which can be fatal if not diagnosed and treated on time.