A rare cardiac manifestation of Brucellosis (RCD code: VIII)

Brucellosis, a zoonosis caused by Gram-negative coccobacilli Brucella, is characterized by a systemic illness with vague symptoms. Though, cardiac involvement with Brucella is reported mostly as endocarditis, the occurrence of exclusive Brucella constrictive pericarditis without endocardium involvement is extremely rare. We report a case of a young patient from a countryside, who presented with low-grade fever, dyspnea and malaise with signs of right heart failure. He was diagnosed with constrictive pericarditis on 2-D echocardiogram and the diagnosis was confirmed by cardiac magnetic resonance. Pericardiectomy was performed to relieve pericardial constriction. The patient, however, continued to have low-grade fever and lethargy. A workup for chronic infections revealed strongly positive titers for Brucella, indicating that the patient was suffering from systemic brucellosis. The patient was treated with combination of antibiotics for six weeks and responded well to the treatment. The case highlights the fact that brucellosis has a wide array of clinical presentations and may present as an isolated exclusive constrictive pericarditis. The diagnosis of brucellosis should always be considered in patients presenting with chronic fever and a history of animal contact.