Acute brucellosis associated with isolated splenic and left gastric artery vasculitis and acute ischemic bowel infarction. A systematic review of the most recent cases

Mariam Ahmed Saad; Eiman Saeed Ahmed; Fahad Ali Alghamdi; Yasser Ragab Fahmy; Yasser Emadeldeen Amin; Ahmed Ahmed Saad

doi:10.53854/liim-2903-19

Acute brucellosis associated with isolated splenic and left gastric artery vasculitis and acute ischemic bowel infarction. A systematic review of the most recent cases

Infez Med. 2021 Sep 10;29(3):469-474. doi: 10.53854/liim-2903-19. eCollection 2021.

Authors

Mariam Ahmed Saad¹, Eiman Saeed Ahmed², Fahad Ali Alghamdi³, Yasser Ragab Fahmy^{4

5}, Yasser Emadeldeen Amin⁶, Ahmed Ahmed Saad^{2

7}

Affiliations

¹ Department of Medical Oncology, National Cancer Institute, Cairo, Egypt.
² Department of Internal Medicine Department, Dr. Erfan and Bagedo General Hospital, Jeddah, Saudi Arabia.
³ Department of Pathology, College of Medicine, King Abdulaziz University, Jeddah, KSA.
⁴ Department of Radiology, Faculty of Medicine Cairo University, Cairo, Egypt.
⁵ Department of Radiology, Dr. Erfan and Bagedo General Hospital, Jeddah, Saudi Arabia.
⁶ Department of Rheumatology, Faculty of Medicine Cairo University, Cairo, Egypt.
⁷ Department of Internal Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt.

Abstract

Brucellosis is a multisystem bacterial zoonosis caused by Gram-negative bacteria Brucella spp. Ingestion of infected food products, direct contact with an infected animal, or inhalation of aerosols are all ways for germs to spread from animals to humans. Intestinal vasculitis with gangrene due to brucellosis has rarely been reported. We report a 62-year-old male patient presenting with acute onset of recurrent attacks of abdominal pain, remittent fever, malaise, and weight loss, which were followed by severe left hypochondrium abdominal pain with rigidity and signs of acute abdomen. Brucellosis was clinically suspected and confirmed by an enzyme-linked immunosorbent assay against the Brucella melitensis species. An abdominal CT scan revealed isolated splenic and left gastric artery vasculitis, leading to acute bowel ischemia, bowel infarction and gangrenous jejunal bowel segment. Histopathological examination of the resected gangrenous bowel segment revealed leucocytoclastic vasculitis. The patient was successfully treated with a standardized antimicrobial therapy for brucellosis and a short course of steroids with a complete resolution of the symptoms and signs. The case is discussed and the literature is reviewed.

Keywords: Brucella melitensis; brucella intestinal vasculitis; intestinal brucellosis; leucocytoclastic vasculitis.

Publication types

Case Reports