Abstract
One of the most prevalent causes of vasculitis is bacterial infection. An infection that causes anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is uncommon and not reported frequently. We report a case of a 74-year-old male who presented with fever for ten days and was found to have brucellosis. Then, he was diagnosed with Guillain-Barré syndrome (GBS) and started on immunoglobulin (IVIG) for one week without a response. His fever was still persistent despite appropriate antibiotic therapy. Rheumatology evaluation revealed a history of multiple joint pain and swelling, elevated inflammatory marker, and a high titer of P-ANCA. Steroid therapy was started initially on the background of antibiotics therapy. His fever and other symptoms showed marked improvement after one week. However, P-ANCA titer was still elevated. The decision was made to treat the patient as a case of brucellosis-induced P-ANCA vasculitis. Azathioprine was added, and steroid was maintained for one month and then it was tapered gradually. All symptoms improved from the third month of follow-up except weakness from peripheral neuropathy with normalization of P-ANCA titer. His condition remained stable after six months of follow-up. Clinicians should be aware of the possibility of infection-induced vasculitis, particularly when patients' symptoms persist despite the appropriate use of antibiotics.
Highlights
Brucellosis is known to be one of the most common zoonotic infections worldwide and has a significant impact on humans, with an increased prevalence in developed countries [1, 2]
We report a case of brucellosis-induced P-anti-neutrophil cytoplasmic antibody (ANCA) vasculitis in a patient with a history of fever, fatigue, polyarthritis, and findings of peripheral neuropathy. e diagnosis of brucellosis was confirmed based on clinical presentation and biochemical evidence with positive Brucella antibodies
The patient received antibiotics to treat brucellosis, but his fever persisted with a lack of response
Summary
Brucellosis is known to be one of the most common zoonotic infections worldwide and has a significant impact on humans, with an increased prevalence in developed countries [1, 2]. Human brucellosis is considered a life-threatening condition and has a nonspecific clinical presentation of intermittent fever, weight loss, depression, hepatomegaly, splenomegaly, and joint pain [2]. Bacterial infection is one of the most common causes of vasculitis, and it can induce it through various direct and indirect mechanisms [5]. E pathogenesis of infections inducing vasculitis is mainly attributed to the immune response caused by the insult in most cases. We report a case of AAV in a patient who presented with fever for ten days, who was discovered to have brucellosis. His fever and overall symptoms improved only after starting immunosuppressive therapy
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