Prolonged combination antibiotic therapy led to significant clinical improvement.
Imaging revealed multiple cavitary lesions and enlarged lymph nodes.
Diagnosis can be challenging and may mimic tuberculosis.
mNGS is crucial for accurate diagnosis in atypical cases.
Guideline-Based Recommendations
Diagnosis
Isolation of Brucella spp. from clinical specimens or positive serology.
Consider metagenomic next-generation sequencing for difficult cases.
Management
Initiate combination antibiotic therapy with doxycycline and rifampicin.
Consider prolonged treatment duration for severe cases, typically 6 months.
Monitoring & Follow-up
Regular follow-up imaging to assess resolution of pulmonary lesions.
Monitor clinical symptoms and laboratory markers of infection.
Risks
Potential for misdiagnosis as tuberculosis.
Delayed treatment due to challenges in diagnosis.
Patient & Prescribing Data
Elderly male with a history of livestock exposure and comorbidities.
Combination therapy with doxycycline, rifampicin, rifapentine, and levofloxacin was effective; monitor for side effects.
Clinical Best Practices
Consider brucellosis in differential diagnosis for cavitary lung lesions in at-risk populations.
Utilize advanced diagnostic techniques like mNGS for accurate identification of pathogens.
Implement a multidisciplinary approach for management of complex cases, involving infectious disease specialists, radiologists, and primary care providers.
