1465 A Rare Cause of Infective Ileocolitis: Brucella Abortus

Abstract

INTRODUCTION: Brucellosis is the world's most widespread zoonotic disease. It is a systemic infection that can involve many organs. The gastrointestinal manifestations of human brucellosis are relatively uncommon and nonspecific such as diarrhea and abdominal pain. Reports of documented specific gastrointestinal lesions caused by Brucella species are rare. CASE DESCRIPTION/METHODS: A 31-year-old male presented with complaints of intermittent fever, chills, and night sweats of 11-month duration. His symptoms were associated with lower abdominal pain and intermittent bleeding per rectum. On physical examination, the patient had mild tenderness to palpation at the lower abdomen. Laboratory tests revealed normal liver enzymes and normal complete blood count. Stool testing for ova or parasites, Clostridium difficile toxins, and stool cultures for pathogenic microorganisms were all negative. Serology testing for Brucella agglutinin titer was positive for Brucella abortus at 1:160; blood culture for Brucella were negative. A pan CT scan revealed hepatomegaly and few sclerotic bony lesions involving thoracic vertebrae. A colonoscopy was performed which showed multiple aphthous ulcers at the terminal ileum (TI) with normal intervening mucosa. There were multiple aphthous ulcers in the cecum, ascending colon and transverse colon. The descending colon, sigmoid colon and rectum appeared normal. Microscopic examination of biopsies from the TI showed focal active ileitis with focal ulceration including infiltration of the lamina propria by mixed acute and chronic inflammatory cells including many eosinophils. Biopsies from the right colon showed focal active colitis with focal ulceration including focal cryptitis and preserved crypt architecture. The patient was diagnosed with brucellosis with ileocolonic involvement, and treated with trimethoprim/sulfamethoxazole and rifampicin given orally for 6 weeks. Four weeks after starting treatment, the patient reported resolution of his fever, abdominal pain and bleeding per rectum. The patient is scheduled to undergo a repeat colonoscopy to evaluate for resolution of ileocolitis endoscopically. DISCUSSION: We report an extremely rare cause of infective ileocolitis due to brucellosis. This appears to be only the fifth well-documented case of brucella colitis; and the first case describing ileocolitis due to brucellosis. Although rare, ileocolitis should be considered in the work-up of patients with brucellosis who have abdominal pain, diarrhea or bleeding per rectum.