Case presentation:
A 40-year-old smoker man, presented to our clinic with low grade fever, arthralgia, and low back pain for several months. He was treating for brucellosis (with doxycycline and rifampin) from 7 days before this presentation, which was admitted for chest pain and dry cough. The lung auscultation revealed decreased breathing sounds and dullness in percussion in the base of right hemi-thorax. Cardiac examination was normal and there was no lymphadenopathy or organomegaly. There was a history of unpasteurized dairy product consumption and brucellosis in his father several years ago.
Chest X-ray (CXR) showed blunting of the right costophrenic angle (CPA) and in lung computed tomography (CT) scan, right pleural effusion without significant parenchymal infiltration was seen. [Figure 1]
Transthoracic echocardiography was normal. The level of the inflammatory markers were high [C-reactive protein (CRP): 38 mg/L (0-1mg/L), erythrocyte sedimentation rate (ESR): 115 mm/hr (<25 mm/hr)], and the platelet (PLT) count that was 502000/mm3. Evaluation of rheumatologic markers were negative (wright test and 2ME were 1/320 and 1/160, respectively). [Table-1 ] Pleural effusion aspirated and analyzed as we showed the results in Table -2. The patient was treated for Brucella pleurisy with gentamicin (240 mg/daily/IV) and ceftriaxone (1g every 12hr / IV) plus rifampin (600mg per day, orally) for 2 weeks. After 5 days, he had no fever, and after 7 days, his chest pain and cough gradually decreased to disappear. Laboratory changes trend showed in Table-1. Medications also changed to oral formulations after 2 weeks with ofloxacin (300mg/daily) (intolerated to doxycycline) plus rifampin for 10 weeks. The patient was followed on 6 and 12 weeks after discharge and he did not have any complications and was improved completely. Lung examination became normal and he was unsatisfied for repeating imaging. Written informed consent was obtained from the patient for publication of this report. This study was conducted according to the declaration of Helsinki principles. Also, CARE guidelines and methodology were followed in this study.