A Very Rare Case of Brucellosis-Related Tubo-ovarian Abscess

A 30-year-old patient presented with persistent left inguinal pain, abdominal pain, and fever for 10 days. Abdominal examination revealed hepatomegaly, splenomegaly, and left lower quadrant and suprapubic region tenderness. An 8 cm diameter abscess was observed in abdominal ultrasonography (Figure 1). Pelvic computed tomography revealed a 69×41 mm abscess with intense inflammation in the surrounding mesenteric area extended up to the iliac vasculature (Figure 2). Brucella spp. was detected in a blood sample. The brucella tube agglutination test was found positive at 1/640. The patient had a history of consuming unpasteurized milk and milk products. Brucellosis was diagnosed based on clinical, laboratory, and radiological findings and the patient history. The patient received doxycycline (2×200 mg), rifampicin (1×600 mg), and trimethoprim-sulfamethoxazole (2×1) therapy. The fever decreased on the third day of treatment, and the abscess contracted (33×40 mm) after 14 days (Figure 3). The gynecologist did not plan surgery due to the clinical and laboratory response and the shrinkage of abscess with treatment.

Brucellosis, a zoonotic infection, is an important public health problem in many developing countries¹. Tubo-ovarian abscess frequently exhibits an acute course together with genitourinary and systemic symptoms². Brucellosis can affect many organs requiring a multidisciplinary approach for patient management. This etiology should be considered in differential diagnosis of patients with tubo-ovarian abscess in endemic regions.

FIGURE 1:
Pelvic ultrasonography showing an 8 cm diameter abscess.

FIGURE 2:
Abdomino-pelvic computed tomography showing a 69×41 mm abscess adjacent to the iliac vascular structures.

FIGURE 3:
Shrinkage of the abscess on the 14^th day of brucellosis treatment.

REFERENCE

• ¹
  Centers for Disease Control (CDC). Brucellosis Reference Guide 2017. https://www.cdc.gov/brucellosis/pdf/brucellosi-reference-guide.pdf (Accessed on May 23, 2019).
  » https://www.cdc.gov/brucellosis/pdf/brucellosi-reference-guide.pdf
• ²
  Bosilkovski M, Krteva L, Dimzova M, Kondova I. Brucellosis in 418 patients from the Balkan Peninsula: exposure-related differences in clinical manifestations, laboratory test results, and therapy outcome. Int J Infect Dis. 2007;11(4):342-7.

Publication Dates

• Publication in this collection
  07 Feb 2020
• Date of issue
  2020

History

• Received
  25 Oct 2019
• Accepted
  11 Dec 2019