Case history
Case history #1
A 30-year-old man presents with a 5-week history of fever, anorexia, arthralgia, and weight loss. He emigrated from Turkey 2 months ago. He has no significant past medical history. His immunizations, including Bacillus-Calmette-Guerin, are up to date. On admission to the hospital, he is febrile, tachycardic, and normotensive. His abdomen is soft and nontender, with an enlarged liver, palpable 2 inches (5 cm) below the costal margin, and enlarged spleen, palpable 1.5 inches (4 cm) below the costal margin. A review of his history shows he had worked extensively with animals in Turkey and had been exposed to their products of conception on several occasions.
Case history #2
A 66-year-old Mexican farmer presents with a 2-year history of lower back pain and intermittent fever. He keeps goats and frequently drinks unpasteurized goats' milk. On physical examination his temperature is slightly elevated and there is mild tenderness over the lower lumbar vertebrae, with no associated deformity or neurologic abnormality.
Other presentations
Brucellosis is known as the great imitator, as it can mimic any disease and affect any organ or system.[1][4] Consequently, it can present in a variety of different ways, with acute nonspecific features or with more focal or localized features. Localized disease commonly includes osteoarticular, hepatosplenic, and genitourinary signs and symptoms. Less common presentations include lymphadenopathy, skin rashes, and pulmonary findings. Depression and lethargy are common; however, more severe neuropsychiatric manifestations occur infrequently. Neurologic manifestations include meningoencephalitis and, rarely, focal brain or cranial nerve lesions.
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