Hepatic Brucelloma: An Unsual Condition

Abstract

Introduction: The most common zoonosis in the world is brucellosis, which is caused by microorganisms of the genus Brucella, a gram-negative aerobic bacteria with the in vivo capability to behave like facultative intracellular parasites. Case: We present the a 49-year-old man complained of abdominal pain in the right hypochondrium associated with fever. Ultrasound, CT, and abdominal MRI scans were performed, which showed a 7-cm hypodense liver lesion in segment VII, with a 2-cm calcification (Image 1). A blood test revealed only elevated CRP levels, without leukocytosis or neutrophilia, and serology of echinococcus granules was negative. Blood cultures were also negative. The affected segment was resected. The postoperative period was satisfactory. Results: Histopathologic analysis determined the presence of a hepatic necrotizing granuloma with internal calcification. The lesion was negative for Zhiel_Neelsen, Grocott, and PAS, but compatible with bruceloma of the liver. Serological diagnosis was subsequently confirmed by means of the Bengal rose test. The patient was then treated with doxycycline with rifampicin for 6 weeks. Hepatic brucelomas appear as single lesions with a pseudotumoral appearance and typically exhibit central calcification. Serological studies are based on the detection of antibodies and are performed with Bengal rose staining. Use of the PCR technique is advisable, both in blood and in the tissue sample. Conclusion: The combination of liver surgery and antibiotic treatment for 6 to 8 weeks is ideal to guarantee complete eradication of this zoonosis, but approximately 5% to 15% of patients relapse.