Brucellosis, a diagnostic dilemma, presenting atypically in a child with terminal ileitis: A case report

Table 1 Laboratory investigations for diagnosis of pyrexia of unknown origin

Laboratory investigations		Results
		First visit to a paediatrician (13 wk prior to visiting us)	Revisit to a pediatrician (8 wk before visiting us)	Tertiary care hospital admission (5 wk before visiting us)	At the time of visiting us	2 mo after treatment completion
Complete blood count	Haemoglobin (g/dL)	11.5	11.3	10	10.5	12.2
	RBC (million/cu mm)	-	-	3.82	4.23	-
	Total leucocyte count (/cu mm)	3700	9600	8100	10640	8430
	Erythrocyte sedimentation rate	30	40	56	60	28
	Neutrophil (%)	56	63	60	45	38
	Lymphocyte (%)	39	30	35	50	52
	Platelet count	Adequate	Adequate	Adequate	Adequate	Adequate
Liver function test		-	-	Serum glutamic-oxaloacetic transaminase -90, Serum Glutamic Pyruvic Transaminase -58	Globulin: 4.3 g/dL, LDH: 365 U/L	Serum glutamic-oxaloacetic transaminase -42, Serum Glutamic Pyruvic Transaminase -29
Serological examination	Dengue nonstructural protein (NS1) antigen	Negative	Negative	Negative	-	-
	C-Reactive protein (mg/dL)	1.18	0.45	0.69	0.503	-
	Brucella serology (IgG and IgM)	-	-	-	Positive	-
	Epstein-Barr virus IgM	-	-	-	Negative	-
	Dual antigen test for malaria	Negative	Negative	Negative	Negative	-
	Widal test	-	TO-1/80, TH- 1/80	-	-	-
Tuberculosis	Cartridge Based Nucleic Acid Amplification Test from the gastric aspirate	-	-	Negative	-	-
	Sputum for acid-fast bacilli	-	-	Negative	-	-
	Mantoux test	-	-	Negative	-	-
Scrub typhus	Weil-Felix test	-	-	Negative	-	-
Automated blood culture		-	-	Negative	Brucella melitensis	-
Routine urine examination		-	-	Normal	-	-
Chest X-ray		-	Normal	-	Normal	-
Ultrasonography whole abdomen		-	Mild splenomegaly	-	Splenomegaly and thickened ileum wall	-

Table 2 Summary of brucellosis cases with terminal ileitis as reported in the literature

Ref.	Country	Age/sex	Presenting Symptoms	Mode of transmission	Blood culture report	Serology report	Radiology report	Treatment	Outcome
Petrella et al[7], 1988	Texas	Child	-	Unpasteurized goat milk cheese consumption	-	-	Ileitis	-	-
Wang et al[8], 2017	China	15/male	Fever, intermittent, diffuse abdominal pain	H/O eating barbecue	Negative	Positive	USG-thickened ileum	Rifampicin and minocycline for 12 wk	Drastic improvement
Oguz et al[9], 2018	Turkey	17/male	Abdominal pain and a fever for 3 d	Cattle contact, recent abortion in cattle	Negative	Positive	USG-terminal ileum was edematous	Rifampicin and doxycycline 6 wk	Drastic improvement
Tamini et al[10], 2019	Jordan	31/male	Fever, chills, night sweats, abdominal pain for 11 mo	-	Negative	Positive	USG-normal, computed tomography -ileocaecal thickening	Rifampicin and cotrimoxazole for 6 wk	Gradual resolution of fever in 4 wk
Santos et al[11], 2020	Portugal	68/female	Night sweats, abdominal pain, weight loss (10%) for 4 mo	-	Positive for Brucella sp.	Positive	USG-thickened ileum	Rifampicin and doxycycline for 10 wk	Remarkable improvement
Noureen et al[12], 2020	Pakistan	32/male	Fever for 1 d, acute abdominal pain for 1 d	Unpasteurized milk consumption	Negative	Positive	Biopsy- ileitis	Surgery for 2 times, followed by rifampicin and doxycycline for 6 wk	Gradual improvement
Alejandro et al[13], 2021	Mexico	56/female	Severe abdominal pain for 12 h	-	-	Positive	Biopsy- ileitis, colitis	Surgery followed by rifampicin + cotrimoxazole for 6 wk	Improvement after surgery

CTScan: Computed tomography scan; USG: Ultrasonography.