Endocarditis brucelis: A case report of a hidden complication

Abstract

Introduction: Endocarditis caused by Brucella infection is one of this infection's complications, including a high mortality rate. However, studies on the prevalence of this complication have been limited to some case reports.

Case presentation: A 40-year-old man who suffered, six years ago, from brucellosis which was treated with antibiotics for 2 months with favorable clinical and biological outcome with no follow-up. Currently the patient presented with a grade III dyspnea of the NYHA classification evolving for six months. The examination revealed a diastolic murmur at the aortic focus. Transthoracic echocardiography showed a severe aortic leak with a suspicious image of perforation and left ventricle dilatation indicating the chronicity of the leak. Cardiac function is preserved and there is no other valvular damage. The patient underwent mechanical valve replacement by vertical median sternotomy.

Discussion: Establishing a diagnosis when endocarditis is the manifestation of brucellosis may be challenging because the clinical presentation is unspecific. Cardiac echocardiography is usually helpful in establishing the diagnosis by showing vegetations, perforations, calcifications and valvular abscesses. Hence a systematic lesion assessment should be carried out to look for other secondary locations in the presence of any symptoms. Cardiac involvement and especially the aortic localization of the disease must be diagnosed and managed rapidly to prevent serious complications.

Conclusion: Brucella endocarditis (BE) is one of the most challenging complications of brucellosis, which is usually diagnosed late in the course of the disease.

Keywords: Brucella; Complication; endocarditis.

Fig. 1

ETT showing a severe aortic leak (A, B) secondary to a suspicious image of anteroposterior cusp perforation (C) (red arrow) with impact on the left ventricle (D).

Fig. 2

Intraoperative photograph of the aortic valve showing a perforation of the anterior-right cusp.

Fig. 3

Intraoperative photograph of anterior-right cusp with a perforation.