A Rare Case of Brucellosis with Multivalvular Endocarditis and Complete Heart Block

Abstract

Background: Brucellosis is a public health concern that affects multiple organs. However, cardiovascular problems arise infrequently, affecting fewer than 2% of cases, typically presenting as endocarditis.

Case presentation: A 50-year male was admitted with low-grade fever, night sweats, weight loss (13 kg), malaise, and generalized weakness for the past 6 months. On clinical examination, he was febrile with 39.0°C, an average heart rate of 54 bpm, and 100/40 mmHg blood pressure. On cardiovascular examination, S1 and S2 were soft with pan systolic murmur present in the mitral area, and the early diastolic murmur was present in the left third intercostal space. Electrocardiography was suggestive of third-degree heart block with AV dissociation. Transthoracic echocardiography showed mobile vegetations attached to multiple valves- an aortic valve (18.2x11.9 mm) and a mitral valve (2.9x7.5 mm) with perivalvular abscess. He was given oral doxycycline (100 mg B.D.) and rifampicin (600 mg/day); the patient responded, but the AV block did not resolve.

Conclusion: This report has drawn attention to multivalvular involvement and cardiac rhythm abnormalities in Brucellosis (in this case, A.V. dissociation was present) because early diagnosis and treatment can cause a significant decrease in morbidity as well as mortality by appropriate treatment.

Keywords: Av block; Brucellosis; contaminated aerosols.; endocarditis; pan systolic murmur; transthoracic echocardiography.

Fig. (1)

ECGs shows complete heart block with AV dissociation.

Fig. (2)

TTE- Long axis parasternal view- in left image M mode shows dense and shaggy echoes on aortic valve (Ao) suggestive of endocarditis with thickened aortic valve and right image shows aortic(asterix) and mitral (arrow) vegetations.