A rare complication of brucellosis: Superinfection of a mature ovarian cystic teratoma

A 43-year-old woman rural dweller working in animal husbandry presented with high fever, chills, nausea, and vomiting. She was diagnosed with brucellosis based on the Brucella standard tube agglutination test and blood culture results. Due to persistent vomiting, she was treated with intravenous tigecycline and oral gentamicin and rifampicin therapy. However, despite appropriate antimicrobial treatment, a clinical and laboratory response was not achieved. The course of inflammation indicators during treatment is shown in Figure 1. Right lower quadrant tenderness was noted on abdominal examination. Magnetic resonance imaging revealed a 12-cm cyst in the region of the right ovary, which was suspected to be a mature cystic teratoma (Figure 2). We performed right ovariectomy and cystectomy (Figure 3). The patient’s fever, nausea, and vomiting resolved from postoperative day 2. İntraoperative cultures of samples of the teratoma yielded Brucella spp. The patient's treatment was switched to rifampicin and doxycycline 2 weeks postoperatively and was discontinued after 8 weeks. Treatment failure in brucellosis is defined as the persistence of disease signs and/or symptoms after the initiation of appropriate antimicrobial therapy¹. The most common complications of brucellosis are osteoarticular and genitourinary involvement². Considering the potential of Brucella to invade several tissues, this case illustrates the importance of genitourinary system evaluation in the event of treatment failure³. Furthermore, tigecycline may be an option for combination therapy in patients with severe brucellosis⁴.

FIGURE 1:
Changes in selected inflammatory markers during the course of treatment.

FIGURE 2:
Mature ovarian cystic teratoma on T2-weighted axial (a) and sagittal (b) magnetic resonance imaging.

FIGURE 3:
Intraoperative images of the ovarian mature cystic teratoma (a), showing the presence of adipose tissue (b), and hair (c) in the cyst.

ACKNOWLEDGMENTS

We thank the nurses involved in the care of this case.

REFERENCES

• ¹
  Solís García del Pozo J, Solera J. Systematic review and meta-analysis of randomized clinical trials in the treatment of human brucellosis. PLoS One. 2012;7(2) e32090.
• ²
  Ozger HS, Karasahin O, Yildiz Y and Dizbay M. Osteoarticular Involvement and Inadequate Treatment of Brucellosis are Related to Relapse. Mediterranean Journal of Infection, Microbes & Antimicrobials. 2020;9(1):NA- NA
• ³
  Uwaydah M, Khalil A, Shamsuddine N, Matar F and Araj G. Brucella-infected ovarian dermoid cyst causing initial treatment failure in a patient with acute brucellosis. Infection 1998; 26: 131-132.
• ⁴
  Dizbay M, Kilic S, Hizel K and Arman D. Tigecycline: its potential for treatment of brucellosis. Scand J Infect Dis. 2007; 39 (5): 432-434.

• Financial Support: None.

Publication Dates

• Publication in this collection
  05 Feb 2024
• Date of issue
  2024

History

• Received
  25 Oct 2023
• Accepted
  12 Dec 2023