Akademik Veri Yönetim Sistemi
Cor et Vasa, cilt.67, ss.7-11, 2025 (ESCI)
Brucella bacteria are Gram-negative coccobacilli that typically cause brucellosis, presenting with nonspecific symptoms like fever, fatigue, and arthralgia. It is a multisystem disease that can lead to complications, with brucella endocarditis being the most common cardiovascular manifestation, though rare. Brucella endocarditis accounts for 80% of brucellosis-related deaths, often due to heart failure. The disease is primarily contracted through unpasteurized dairy products. Diagnosing brucellosis can be challenging due to its diverse clinical features. Brucella-related prosthetic valve endocarditis is particularly rare and presents unique diagnostic and treatment difficulties. We present a case report of brucella endocarditis in a male patient in his 50s. His medical history was insignificant except a history of mitral valve replacement due to acute rheumatic fever. He had a history of relapsing fever, night sweat and weight loss over a year. There were diverse laboratory findings such as elevated acute phase reactants, liver enzymes, hematuria, low c3/c4, positive antinuclear antibody and rheumatoid factor. During cardiac auscultation, a pansystolic murmur grade 2/6 was detected at the mitral focus, accompanied by the audible sound of a metallic prosthetic valve. Blood cultures from both arms were taken over four days. The first culture showed Gram-negative bacterial growth at 72 hours, prompting empirical treatment with cefepime and gentamicin. After 5 days, Brucella was identified, and the treatment was adjusted to doxycycline, rifampicin, and gentamicin. No growth was seen in cultures taken after starting empirical treatment. Subsequently, a transesophageal echocardiogram was performed, revealing a 13 mm vegetative mass consistent with prosthetic mitral valve vegetations. The patient then underwent surgery, and no complications were observed in the postoperative period.