Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 6, 2021; 9(4): 927-934
Published online Feb 6, 2021. doi: 10.12998/wjcc.v9.i4.927
Atypical presentation of shoulder brucellosis misdiagnosed as subacromial bursitis: A case report
Fu-Sheng Wang, Khurram Shahzad, Wei-Guo Zhang, Jie Li, Kang Tian
Fu-Sheng Wang, Khurram Shahzad, Wei-Guo Zhang, Jie Li, Kang Tian, Department of Bone and Joint, First Hospital of Dalian Medical University, Dalian 116000, Liaoning Province, China
Author contributions: Tian K and Wang FS collected the clinical data; Tian K drafted the manuscript and designed the case report; Shahzad K performed the pathogen identification analysis; Zhang WG and Li J critically reviewed the manuscript; All authors read and approved the final manuscript.
Supported by National Natural Science Foundation of China, No. 81601901; Natural Science Foundation of Liaoning No. 2019-MS-079 and No. 20170540285.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kang Tian, MD, PhD, Doctor, Professor, Department of Bone and Joint, First Hospital of Dalian Medical University, No. 193 Lianhe Road, Dalian 116000, Liaoning Province, China. dmu-tiankang@outlook.com
Received: October 4, 2020
Peer-review started: October 4, 2020
First decision: November 8, 2020
Revised: November 10, 2020
Accepted: December 17, 2020
Article in press: December 17, 2020
Published online: February 6, 2021
Abstract
BACKGROUND

Brucella infections in the shoulder joint are uncommon, and few have been reported in the literature.

CASE SUMMARY

A 26-year-old male was admitted to our hospital with complaint of recurrent pain and limited movement of the right shoulder. The patient reported the pain to have first occurred as an isolated event 6 mo previously and to have reoccurred 5 mo later, when it was accompanied by limited movement of the shoulder. Findings from physical examination and magnetic resonance imaging (referred to as MRI) suggested the diagnosis of subacromial bursitis, and diagnostic paracentesis and arthroscopic debridement were performed. Surprisingly, synovial fluid culture detected brucella, and the finding was confirmed by mass spectrometry of a colony sample. The diagnosis was corrected to brucellosis of the shoulder joint, and antibiotic drug treatment (oral rifampicin and doxycycline) was administrated for 6 wk. The 4-mo postoperative follow-up examination (MRI) yielded normal findings. The 2-year follow-up showed no signs of recurrence.

CONCLUSION

This rare case of brucellosis infection in shoulder highlights the importance of increasing awareness to help avoid misdiagnosis.

Keywords: Shoulder, Misdiagnosis, Brucellosis, Subacromial bursitis, Brucella, Case report

Core Tip: We report our first encounter of a case of brucellosis in the shoulder joint, which was initially misdiagnosed as subacromial bursitis. A 26-year-old male was admitted with recurrent pain and limited movement of the right shoulder. The pain reportedly occurred first 6 mo previously and reoccurred 5 mo later, accompanied by limited movement of the shoulder. Diagnostic paracentesis and arthroscopic debridement were performed. Surprisingly, brucella growth was detected from the synovial fluid and confirmed by colony sample analysis using mass spectrometry. This case report is intended to increase awareness for brucellosis and help avoid future misdiagnoses by orthopedists and physicians.