Who moved my cheese ? An interesting case of neurobrucellosis in a man residing in the United states
AAPA ePoster library. Fox P. 05/17/17; 180551; 229
Patrick Fox
Patrick Fox
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Title: Who moved my cheese? An interesting case of neurobrucellosis in a man residing in the United States. Authors: Patrick Fox, PA -C, Elan Gada, MD Introduction: This case illustrates a rare presentation of brucellosis, a zoonotic infection found primarily in the Middle East and Latin America, which may be transmitted through consumption of unpasteurized foods. Brucella commonly has an incubation period of 2-4 weeks in humans (1). Here we show how brucellosis may be a diagnostic consideration in persons living in the United States and how a food history may be an important component of an intake History & Physical Exam. Case presentation: A 48 year old man with no significant past medical history who presented to the Emergency Room with transient headaches, arthralgia, and difficulty with expressing some words for one month. He had normal vital signs and an unremarkable physical exam. His laboratory findings were remarkable for: H/h 10.1/28.7, PLT 111, AST 160 and ALT 164. His MRI brain showed no intracranial abnormality. He was discharged with follow-up. The patient returned to the Emergency Room two weeks later, having been notified by the County Health Department that he belonged to a group of workers who had ingested a brucella contaminated cheese from Mexico two months prior. On this occasion, the patient had a fever of 100.5. His physical exam was remarkable for hepatosplenomegaly. His laboratory findings were remarkable for: H/h 9.4/27.7, PLT 142, AST 187, ALT 141 and CRP 12.1. His MRI brain demonstrated diffuse pachymeningeal thickening and increased white matter changes with no evidence of acute infarct. The patient's lumbar puncture was unremarkable, but his blood cultures were positive for Brucella Melitensis. He was admitted and treated successfully with IV antibiotics. Discussion: Brucellosis may encompass a wide range of clinical manifestations including fevers, arthralgia, fatigue, sweating, and chills (2). The initial diagnostic considerations for our patient included HIV, syphilis, thyroid disorders, meningitis, and stroke. A travel history was taken, but a history of ingestion of contaminated foods or of contact with infected animals was not and would have been helpful in this case. The most common physical examination finding is hepatosplenomegaly, and the most common laboratory abnormalities include an elevation in CRP, anemia, and transaminitis, all of which our patient displayed (2). The gold standard of diagnosis is blood...
Title: Who moved my cheese? An interesting case of neurobrucellosis in a man residing in the United States. Authors: Patrick Fox, PA -C, Elan Gada, MD Introduction: This case illustrates a rare presentation of brucellosis, a zoonotic infection found primarily in the Middle East and Latin America, which may be transmitted through consumption of unpasteurized foods. Brucella commonly has an incubation period of 2-4 weeks in humans (1). Here we show how brucellosis may be a diagnostic consideration in persons living in the United States and how a food history may be an important component of an intake History & Physical Exam. Case presentation: A 48 year old man with no significant past medical history who presented to the Emergency Room with transient headaches, arthralgia, and difficulty with expressing some words for one month. He had normal vital signs and an unremarkable physical exam. His laboratory findings were remarkable for: H/h 10.1/28.7, PLT 111, AST 160 and ALT 164. His MRI brain showed no intracranial abnormality. He was discharged with follow-up. The patient returned to the Emergency Room two weeks later, having been notified by the County Health Department that he belonged to a group of workers who had ingested a brucella contaminated cheese from Mexico two months prior. On this occasion, the patient had a fever of 100.5. His physical exam was remarkable for hepatosplenomegaly. His laboratory findings were remarkable for: H/h 9.4/27.7, PLT 142, AST 187, ALT 141 and CRP 12.1. His MRI brain demonstrated diffuse pachymeningeal thickening and increased white matter changes with no evidence of acute infarct. The patient's lumbar puncture was unremarkable, but his blood cultures were positive for Brucella Melitensis. He was admitted and treated successfully with IV antibiotics. Discussion: Brucellosis may encompass a wide range of clinical manifestations including fevers, arthralgia, fatigue, sweating, and chills (2). The initial diagnostic considerations for our patient included HIV, syphilis, thyroid disorders, meningitis, and stroke. A travel history was taken, but a history of ingestion of contaminated foods or of contact with infected animals was not and would have been helpful in this case. The most common physical examination finding is hepatosplenomegaly, and the most common laboratory abnormalities include an elevation in CRP, anemia, and transaminitis, all of which our patient displayed (2). The gold standard of diagnosis is blood...
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