SELÇUK NAZİK, SÜHEYLA KÖMÜR, ASLIHAN ULU, Taylan BOZOK, Behice KURTARAN, AYŞE SEZA İNAL, Yeşim TAŞOVA, Hasan Salih Zeki AKSU

Pulmoner Bruselloz Olgu Sunumu

Bruselloz; ülkemizde endemik olarak görülen, tekrarlayan ateş, eklem ağrısı, halsizlik, iştahsızlık ile seyreden sistemik bir hastalıktır. Solunum sistemi tutulumunda en sık görülen semptom %10-33 ile non prodüktif öksürüktür. Olgumuz, 76 yaşında, erkek hasta kırsal bölgede çiftçilik ile uğraşıyor. On beş gündür devam eden kuru öksürük, üşüme-titreme ile yükselen ateş ve uykuya eğilim şikayetleri ile enfeksiyon hastalıkları servisine yatışı yapıldı. Özgeçmişinde taze peynir tüketimi mevcuttu. Hastaya ampirik sefrtriakson 2x2 gr ve klindamisin 4x600 mg IV başlandı. Brusella agglutinasyonu 1/160 titrede pozitif olarak saptandı. Doksisiklin 2x100 mg ve rifampisin 2x300 mg başlandı. Toraks bilgisayarlı tomografisinde (BT) pnömoni, solda minimal plevral efüzyon izlendi. Pnömoni etkenleri serolojik olarak dışlandı. Bruselloz tedavisinin 5. gününde hastanın ateşi düştü, genel durumu düzeldi ve akciğer dinleme bulgularında düzelme görüldü. Kan kültüründe Brucella melitensis üremesi oldu. Tedavisi 8 haftaya tamamlanan hastada klinik ve radyolojik olarak düzelme görüldü. Ülkemizde endemik olarak görülen brusellozun nadir görülen pulmoner tutulumu, pnömoni ile başvuran hastalarda ayırıcı tanıda akılda tutulmalıdır

Pulmonary Brucellosis Case Report

Brucellosis, an endemic disease in our country, is a systemic disorder characterized with recurrent fever, joint pain, malaise and anorexia. Although it may affect many systems, respiratory involvement is quite rare. In case of respiratory system involvement, the most common (10-33%) symptom is non-productive cough. Our patient was a 76 year old male living in rural areas engaged in farming. He was hospitalized with fifteen days ongoing complaints, dry cough, fever with chills and tendency to sleep. On physical examination, fever, tachypnea, decreased breath sounds at left lung baseline and crepitan crackles at right baseline and loss of muscle strength was present. In his history, fresh cheese consumption was present. Empirically, ceftriaxone and clindamycin was initiated. Brucella agglutination was 1/160 titer positive. Doxycycline and rifampin was started. Thoracic computed tomography revealed pneumonia and minimal pleural effusion on the left lobe. The other pneumonia agents were excluded serologically. Cerebrospinal fluid revealed normal findings. Neurobrucellosis was excluded. On the fifth day of brucellosis treatment patient was afebrile, general condition improved and lung symptomsand findings resolved. Blood culture was positive for Brucella melitensis. The patient completed 8 weeks of treatment, clinical and radiological improvement was seen. Brucellosis, an endemic disease in our country, rarely shows pulmonary involvement and it should be kept in mind in differential diagnosis in patients admitted with pneumonia

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