Focused brucellosis: about an atypical case

Abstract

Brucellosis is still endemic in Tunisia where it poses a real public health problem. We report the case of a 69-year-old man, with no significant medical history, residing in a rural area of Siliana, referred to the ENT surgery department of the Habib Thameur hospital in Tunis for a right laterocervical mass evolving for 3 days. Clinical examination showed a painful mass with 7 cm of major axis. It was a cervico-facial cellulitis associated with pyomyositis of the homolateral sternocleidomastoid muscle. The pus resulting from the dissection of the mass was addressed to our microbiology laboratory . Its culture on blood agar showed very fine and non-hemolytic punctiform colonies after 3 days of incubation. Gram staining showed small Gram-negative coccobacilli. Catalase and oxidase tests were positive. The urease test was positive within 30 minutes. Brucella melitensis was identified with Api 20 NE^© BioMérieux and Viteck^© 2 BioMérieux. Antibiotic treatment combining Doxycycline^© 200 mg/day and Rifampicin^© 900 mg/day has been initiated. Brucellosis is a widespread anthropozoonosis in Tunisia. Given its insidious evolution, it remains a diagnosis to evoke in front of a misleading clinical situation , especially in endemic countries like ours.