eISSN: 1897-4252
ISSN: 1731-5530
Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery
Current issue Archive Manuscripts accepted About the journal Supplements Editorial board Reviewers Abstracting and indexing Contact Instructions for authors Ethical standards and procedures
Editorial System
Submit your Manuscript
SCImago Journal & Country Rank
2/2016
vol. 13
 
Share:
Share:

Simultaneous acute deep vein thrombosis and acute brucellosis. A case report

Salih Salihi
,
Şeyda Andaç
,
Mehmet Kalender
,
Onur Yıldırım
,
Ayfer İmre

Kardiochirurgia i Torakochirurgia Polska 2016; 13 (2): 162-163
Online publish date: 2016/07/03
Article file
Get citation
 
PlumX metrics:
 

Introduction

Brucellosis is a zoonotic disease of worldwide distribution that mainly affects persons working with domestic animals and animal products. Despite being controlled in many developed countries, the disease remains endemic in many parts of the world, including Latin America, the Middle East, parts of Africa, and western Asia. The clinical presentation can vary from asymptomatic infection with seroconversion to a full-blown clinical picture of fever, night sweats and joint manifestations; occasionally, there is hepatic, cardiac, ocular or central nervous system involvement [1]. Vascular complications, including arteries and veins, associated with Brucella infection have rarely been reported [2].
In this paper, a case of deep venous thrombosis (DVT) developing after a diagnosis of acute brucellosis in a young milkman is presented. Apparently, this case report is the second case of DVT due to brucellosis in Turkey.

Case report

A 26-year-old man presented to our hospital with a 1-week history of pain and swelling in the right leg. He had been dealing with milk. Two hour before, his leg had become swollen and purple. The patient’s medical history included a diagnosis of brucellosis 1 week previously in our hospital, where he had presented with complaints of weakness and fever. The Rose-Bengal test was positive; the Brucella tube agglutination test result was 1/160. He was put on rifampicin and doxycycline therapy.
On physical examination, the patient was in a painful condition. Peripheral pulses were weak in the right leg but strong in the other. The right leg was hot, swollen and purple. The Hoffman test was positive on the right leg. His cardiopulmonary and neurological examinations were unremarkable.
Laboratory analyses revealed the following results: white blood cell count 8,000/µl, hemoglobin 14.2 g/dl, platelet count 226,000/µl, alanine aminotransferase (ALT) 69 U/l, aspartate aminotransferase (AST) 92 U/l. Chest X-ray film disclosed the heart and pulmonary vessels to be of normal size, and electrocardiogram (ECG) showed a sinus rhythm. Color venous Doppler ultrasound of the right lower extremity revealed increased diameter of the right main, deep and superficial femoral veins, the popliteal vein and the cranial segments of the deep crural veins; the lumens of these vessels were occluded with thrombosis. There was no blood flow in the vascular lumen, and there was no response in the veins to compression. The patient was diagnosed with acute deep vein thrombosis. The patient was hospitalized in the Department of Cardiovascular Surgery. Rifampicin 600 mg/day per oral, doxycycline 400 mg/day per oral and heparin sodium 20 000 units/day intravenous in divided doses were administered. He was also given warfarin sodium 5 mg/day per oral simultaneously. Heparin was stopped when the INR values reached a therapeutic level. He was discharged on day seven of hospitalization with regression of complaints and physical examination findings. On discharge, he was prescribed warfarin 5 mg/day, rifampicin 600 mg/day and doxycycline 100 mg/day per oral.

Discussion

Brucellosis is a systemic infection that can involve any organ or organ system of the body, and since many cases go unrecognized, the true incidence of the disease is unknown [3]. The onset may be sudden, over a few days, or gradual over weeks to months, with nonspecific symptoms including fever, lassitude, malaise, headache, backache, and arthralgia [4]. Sometimes, the manifestations of brucellosis are more pronounced in a specific organ system.
Vascular complications, including arteries and veins, are rare in brucellosis. In a review of articles, reported cases included abdominal artery thrombosis, portal vein thrombosis and cerebral vein thrombosis [2, 4-11]. The disease is mainly transmitted to humans through the ingestion of raw milk or non-pasteurized cheese contaminated with one of the four Brucella species pathogenic to humans. Species causing vascular complications have been identified as B. melitensis, B. abortus and B. suis [5].
Endothelial damage, hypercoagulability, and stasis have been recognized for over 150 years to be the three elements associated with venous thromboembolism (VTE), with often two of these three factors needed for its initiation. Therefore, its etiology is multifactorial, with each component having different impacts on different patients. Brucella infections may cause DVT due to the following mechanisms: invasion of the surrounding tissue by the infectious agent, inflammation caused by the infectious process in the surrounding tissue, direct damage to the endothelium caused by the infectious agent, and temporary hypercoagulopathy caused by the infectious agent [5, 10]. In our patient, there are no abnormal results for the etiological factors that cause thrombosis such as protein C, protein S and anticardiolipin IgG and IgM. We believe that DVT in our patient was associated with Brucella infection, as there were no risk factors for venous thrombosis such as immobilization, history of previous DVT, recent surgical intervention or local tissue trauma.

Conclusions

Early detection and appropriate treatment of brucellosis are crucial measures to prevent complications of the disease. Patients presenting with symptoms of DVT or similar vascular pathologies should be assessed for infectious agents, particularly in those coming from Brucella-endemic areas.

Disclosure

Authors report no conflict of interest.

References

1. Memish ZA, Balkhy HH. Brucellosis and international travel. J Travel Med 2004; 11: 49-55.
2. Colmenero JD, Reguera JM, Martos F, Sánchez-De-Mora D, Delgado M, Causse M, Martín-Farfán A, Juárez C. Complications associated with Brucella melitensis infection: a study of 530 cases. Medicine 1996; 75: 195-211.
3. Al Sekait MA. Seroepidemiological survey of brucellosis antibodies in Saudi Arabia. Ann Saudi Med 1999; 19: 219-222.
4. Young EJ, Hall WH. Brucellosis. In: Bacterial infection of humans: epidemiology and control. 3rd ed. Evans AS, Brachman PS (eds.). Plenum Medical Book Company, New York 1998; 155-167.
5. Odeh M, Pick N, Oliven A. Deep venous thrombosis associated with acute brucellosis: a case report. Angiology 2000; 51: 253-256.
6. Sanchez-Gonzales J, Garcia-Delange T, Martos F, Colmenero JD. Thrombosis of the abdominal aorta secondary to Brucella spondylitis. Infection 1996; 24: 261-262.
7. Gelfand MS, Kaiser AB, Dale WA. Localized brucellosis: popliteal artery aneurysm, mediastinitis, dementia and pneumonia. Rev Infect Dis 1989; 11: 783-788.
8. Gregori J, Ortuńo J, Ruiz Rivas JL, Arenas M. Brucellosis and portal thrombosis. Rev Esp Enferm Dig 1990; 78: 187-188.
9. Zaidan R, Al Tahan AR. Cerebral venous thrombosis: a new manifestation of neurobrucellosis. Clin Infect Dis 1999; 28: 399-400.
10. Kocak S, Dikmetas C, Dundar Z, Kesli R. Acute deep venous thrombosis associated with acute brucellosis: a case report. JAEMCR 2012; 3: 118-120.
11. Meidani M, Mirzadeh F, Sadeghi A. Simultaneous deep vein thrombosis and acute brucellosis: case report. J Med Sci 2012; 19: 40-42.
Copyright: © 2016 Polish Society of Cardiothoracic Surgeons (Polskie Towarzystwo KardioTorakochirurgów) and the editors of the Polish Journal of Cardio-Thoracic Surgery (Kardiochirurgia i Torakochirurgia Polska). This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License (http://creativecommons.org/licenses/by-nc-sa/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
Quick links
© 2024 Termedia Sp. z o.o.
Developed by Bentus.