ID Fellows Cup Question 3

Correct Answer: Brucellosis

This patient’s occupation as a cattle farmer with potential ingestion of unpasteurized dairy products puts him at risk for the diagnosis Brucellosis. Humans are generally infected through the consumption of infected, unpasteurized animal-milk products, direct contact with infected animal parts, or inhalation of infected aerosolized particles.

Presentation of Brucellosis:

  • Fever is almost always present.
  • Extremely malodorous perspiration has been described as an almost pathognomonic symptom.
  • Osteoarticular manifestations are most common, peripheral arthritis > sacroiliitis > spondylitis.
  • Reproductive system is a common site of focal disease including epididymo-orchitis in men, as seen in our case.
  • Invasive presentations such as endocarditis and meningitis also occur
  • Exam: Hepatosplenomegaly and lymphadenopathy may be seen
  • Labs: Generally mild- ↑ transaminases, leukopenia, and relative lymphocytosis

Distractor answer choices

  • Tuberculosis may present with all these symptoms including epididymo-orchitis, but this patient is not from an endemic area and has no risk factors. Additionally, the time course fits better with Brucella.
  • Case reports of lymphoma related epididymo-orchitis exist but this would be incredibly rare
  • The question stem provides no risk factors for sexually transmitted infections and the constellation of signs and symptoms fits best with Brucella

Gorgas www.uab.edu/medicine/gorgas/cases-blog/2010/160-2010-case-4

NEJM (included table from here) www.nejm.org/doi/full/10.1056/NEJMra050570

Author: Mauricio Kahn at UAB

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