Makaritsis Konstantinos P, Liaskos Christos, Papadamou Georgia, Dalekos George N
Department of Medicine and Research Laboratory of Internal Medicine, Medical School, University of Thessaly, Larissa, Greece.
BMJ Case Rep. 2015 Apr 22;2015:bcr2015209387. doi: 10.1136/bcr-2015-209387.
Brucellosis is a common zoonotic disease with worldwide distribution and protean clinical manifestations. Therefore, its prompt and timely diagnosis is still challenging. Among several complications of brucellosis, spontaneous bacterial peritonitis (SBP) in previously healthy participants is rarely recognised, although this condition can be fatal if misdiagnosed and untreated. We present a case of a 69-year-old previously healthy stockbreeder who suffered from back pain along with abdominal pain and distension because of ascites of 6-8 weeks duration. Cultures of ascitic fluid and peripheral blood specimens revealed Brucella spp as the causative agent of ascites and spondylodiscitis, which was then confirmed by MRI findings. After appropriate treatment for 4.5 months (streptomycin 1 g/day for 3 weeks intramuscularly, doxycycline 100 mg twice a day orally and rifampicin 900 mg/day orally), the patient fully recovered. Conclusively, in the appropriate epidemiological and clinical setting, the consideration of brucellosis in the differential diagnosis of SBP could be rational as well as life-saving.
布鲁氏菌病是一种常见的人畜共患病，呈全球分布，临床表现多样。因此，其及时诊断仍具有挑战性。在布鲁氏菌病的几种并发症中，既往健康者发生的自发性细菌性腹膜炎（SBP）很少被认识到，尽管这种情况如果误诊和未治疗可能是致命的。我们报告一例69岁既往健康的饲养员病例，该患者因持续6 - 8周的腹水出现背痛伴腹痛和腹胀。腹水和外周血标本培养显示布鲁氏菌属为腹水和脊椎间盘炎的病原体，随后MRI检查结果证实了这一点。经过4.5个月的适当治疗（链霉素1g/天，肌内注射3周，强力霉素100mg，口服，每日2次，利福平900mg/天，口服），患者完全康复。总之，在适当的流行病学和临床背景下，在SBP的鉴别诊断中考虑布鲁氏菌病既合理又能挽救生命。
