Title:A Rare Case of Brucellosis with Multivalvular Endocarditis and Complete
Heart Block
Volume: 20
Issue: 6
Author(s): Sunil Kumar Gothwal*, Kanika Goyal, Ajay Shankar Garg, Bharat Kumar Sahu, Mohit Agrawal, Anurag Mishra, Yogendra Singh, Vetriselvan Subramaniyan, Neelam Singla, Md Sadique Hussain and Gaurav Gupta
Affiliation:
- Department of Medicine, Jawaharlal Nehru Medical College, Ajmer, Rajasthan, India
Keywords:
Brucellosis, endocarditis, transthoracic echocardiography, pan systolic murmur, Av block, contaminated aerosols.
Abstract:
Background: Brucellosis is a public health concern that affects multiple organs.
However, cardiovascular problems arise infrequently, affecting fewer than 2% of cases, typically
presenting as endocarditis.
Case Presentation: A 50-year male was admitted with low-grade fever, night sweats, weight
loss (13 kg), malaise, and generalized weakness for the past 6 months. On clinical examination,
he was febrile with 39.0°C, an average heart rate of 54 bpm, and 100/40 mmHg blood pressure.
On cardiovascular examination, S1 and S2 were soft with pan systolic murmur present in the mitral
area, and the early diastolic murmur was present in the left third intercostal space. Electrocardiography
was suggestive of third-degree heart block with AV dissociation. Transthoracic
echocardiography showed mobile vegetations attached to multiple valves- an aortic valve
(18.2x11.9 mm) and a mitral valve (2.9x7.5 mm) with perivalvular abscess. He was given oral
doxycycline (100 mg B.D.) and rifampicin (600 mg/day); the patient responded, but the AV
block did not resolve.
Conclusion: This report has drawn attention to multivalvular involvement and cardiac rhythm
abnormalities in Brucellosis (in this case, A.V. dissociation was present) because early diagnosis
and treatment can cause a significant decrease in morbidity as well as mortality by appropriate
treatment.