Abdulrahman Binar B, Sadq Botan N, Shareef Farman U, Abdul Aziz Jeza M, Rasheed Mariwan K
Biomedical Sciences, Komar University of Science and Technology, Sulaymaniyah, IRQ.
Medical Microbiology, Koya University, Sulaymaniyah, IRQ.
Cureus. 2024 Jul 30;16(7):e65740. doi: 10.7759/cureus.65740. eCollection 2024 Jul.
Brucellosis remains a widespread disease in endemic regions worldwide and is not adequately controlled. It is a common zoonotic disease worldwide, a systemic infection, and a major health problem in endemic countries. Femoral head avascular necrosis (FHAVN) as a consequence of brucellosis is exceedingly unusual and has seldom been recorded. The case reports a 21-year-old female patient was hospitalized due to severe pain in both lower limbs, particularly in the anterior portion of the hip joint, accompanied by a low-grade fever persisting for six months. Movement of the right hip was painful, and the patient limped at the beginning of walking after a few steps. Rheumatoid factor and antinuclear antibody test results were negative. The right hip joint was aspirated, and a small quantity of fluid was sent for Gram staining and culture. Synovial joint fluid culture confirmed Brucella abortus infection after four weeks. The source of infection in the present case was the consumption of raw milk. Based on laboratory tests and radiographic images, FHAVN was diagnosed. Owing to misdiagnosis, she had not received standard treatment for brucellosis in the previous months. The patient was diagnosed early, and she was in the third stage. After the patient received medical treatment, the left and right hip joints partly recovered. The right hip joint required replacement; however, the patient refused. Attending physicians should consider brucellosis as an alternative to arthritis for hip joint pain in Brucella-endemic locations. Medication-based therapy may be effective for early avascular necrosis, emphasizing the need for early diagnosis and treatment.
布鲁氏菌病在全球流行地区仍然是一种广泛传播的疾病，且未得到充分控制。它是一种常见的人畜共患病，是一种全身性感染，也是流行国家的一个主要健康问题。作为布鲁氏菌病后果的股骨头缺血性坏死极为罕见，鲜有记录。该病例报告了一名21岁女性患者因双下肢严重疼痛，尤其是髋关节前部疼痛，并伴有持续六个月的低热而住院。右髋关节活动时疼痛，患者行走几步后开始跛行。类风湿因子和抗核抗体检测结果均为阴性。对右髋关节进行了穿刺，抽取少量液体送去进行革兰氏染色和培养。四周后，滑膜液培养证实感染了流产布鲁氏菌。本病例的感染源是饮用生牛奶。根据实验室检查和影像学图像，诊断为股骨头缺血性坏死。由于误诊，她在前几个月未接受布鲁氏菌病的标准治疗。该患者早期被诊断，处于第三阶段。患者接受治疗后，左、右髋关节部分恢复。右髋关节需要置换，但患者拒绝了。在布鲁氏菌病流行地区，主治医生应将布鲁氏菌病视为髋关节疼痛性关节炎的一种鉴别诊断。基于药物的治疗可能对早期缺血性坏死有效，强调早期诊断和治疗的必要性。
