Published online Oct 19, 2023. doi: 10.5495/wjcid.v13.i3.24
Peer-review started: June 19, 2023
First decision: August 30, 2023
Revised: September 4, 2023
Accepted: September 22, 2023
Article in press: September 22, 2023
Published online: October 19, 2023
Brucellosis is endemic in India with seropositivity rates as high as 10% in children in the eastern states, yet the disease is not on the radar when a differential diagnosis of pyrexia of unknown origin (PUO) is being considered, especially in children in urban set-up. This may be because of the non-specific multitude of systemic symptoms seen in this disease and the lack of awareness among clinicians.
We present a case of a 13-year-old boy, who came with a history of undulating fever for the past three and a half months, loss of appetite, and abdominal pain. The child had visited several pediatricians and was even admitted to a tertiary care hospital for PUO evaluation, but to no avail. He presented to us after three and half months of suffering and weight loss of more than 10% of body weight. His ultrasonography revealed thickening of the terminal ileum. His blood culture grew Brucella melitensis. A diagnosis of Brucellosis with terminal ileitis was made. Brucella serology by enzyme-linked immunoassay (ELISA) was positive for both IgG and IgM. He was treated with doxycycline and Rifampicin along with syrup multivitamin and zinc, for 6 wk. There was remarkable improvement with gain in 4 kg body weight within 2 mo of completing treatment. History revealed con
Clinical suspicion, detailed history, appropriate laboratory investigations are the three pillars for diagnosing Brucellosis in patients presenting with vague symp
Core Tip: Pyrexia of unknown origin has always been a diagnostic challenge for clinicians, in spite of development of most modern diagnostic techniques. The decision to choose the right investigation depends on the clinician’s acumen which in turn is guided by detailed history-taking and knowledge of local disease prevalence, leading to timely diagnosis with prevention of mental, physical and financial agony. Our child suffering for three-and-half months, could have landed in the emergency department with acute abdomen, had there been a further delay in the diagnosis of his vague symptoms that were due to Brucellosis presenting atypically with terminal ileitis.