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
Links
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