Simultaneous deep vein thrombosis and acute brucellosis: case report

Brucellosis is a zoonotic disease that is common in developing countries such as Iran which is a serious medical impact. Vascular complications, including arterial and venous associated with Brucella infection, have rarely been reported. In a review of articles, it is clear that, only five cases of deep venous thrombosis (DVT) of the lower extremities and just one case of cerebral venous thrombosis, associated with brucellosis have been reported so far. In this article a case of DVT of the left leg in association with acute Brucella infection was reported. Apparently, this case report is the first case of DVT due to brucellosis in Iran. Patient is a 28-year-old male who presented with clinical manifestations of fever, unilateral calf pain and swelling. Peripheral venous doppler ultrasound showed DVT and patient was treated with anti coagulants. Through controlling the fever and decreasing the lower extremity. The patient discharged with warfarin therapy. During follow up, the patient came back with repeated fever, sweating, myalgia and bilateral knee swelling. Because of patient clinical manifestation and epidemiologic status, brucellosis serology test was recommended, which was positive in high titer. He was discharged with a prescription of anti-brucellosis treatment. In the course of treatment, the patient referred to hospital due to sudden dyspnea, cough, hemoptysis, pleuretic chest pain. In spiral CT with protocol PTE, pulmonary thrombo emboli was detected and standard therapy for PTE was administered. In the course of his hospitalization other etiologies of thrombo phelebitis were excluded. Finally, the patient's clinical presentation subsided with warfarin therapy and anti brucellosis multi drug regimen. Early detection and appropriate treatment of Brucellosis are crucial measures to prevent problematic complications of the disease. The author's case and those previously reported, suggest that brucellosis should be included among the etiologies and the infections which are taken into account in patients suffering from DVT, particularly in those coming from Brucella-endemic areas.