Epididymo-orchitis due to brucellosis: not only to be considered in endemic areas. Two cases for the price of three patients

Abstract

We report 2 patients with epididymo-orchitis, caused by Brucella melitensis, accompanied by severe delay of diagnosis. In 1 patient the correct diagnosis was only suspected after his wife had been diagnosed with brucellosis. Our cases illustrate that diagnosing brucellosis can be difficult in nonendemic areas, especially when physicians are unfamiliar with it. Important clues pointing to brucellosis as cause of epididymo-orchitis are a travel history to endemic areas, unresponsiveness to empiric antibiotic treatment, and a preceding period of episodic subfebrile temperature, night sweats and fatigue. Serology is the diagnostic test of choice because it is faster and more sensitive than blood cultures. Delay of diagnosis may lead to serious complications. Therefore, alertness for brucellosis is warranted, also, if not especially, in nonendemic areas.