[Brucellosis as an imported disease in a young man with arthritis]. / Brucellose als importziekte bij een jonge man met artritis.

ABSTRACT

A 23-year-old man was admitted to hospital with an extremely painful sacroiliitis on the left side. He had been back in The Netherlands for 5 weeks after a one-year stay on a farm in India where he consumed unpasteurised cow's milk almost daily. Three months before admission he had been ill for several weeks with high fever, a painful right hip joint and night sweats. He was diagnosed in India as having coxitis, thought to be due to a Giardia infection. After hospitalisation in The Netherlands, he developed daily high fever with chills and Brucella sacroiliitis was diagnosed via a positive serology, later confirmed by a positive blood culture for Brucella melitensis. The patient was treated with doxycycline and rifampicin but due to persistent fever, gentamicin was later added for 7 days. As a result of nausea related to rifampicin, this was changed to ciprofloxacin. During treatment he also developed a severely painful right coxitis, possibly due to local release of bacterial endotoxins from a previous Brucella infection in India. After three months of antibiotic treatment, he recovered fully. Although brucellosis is a rare imported disease in The Netherlands, the possibility must be kept in mind in cases of arthritis following a stay in the (sub)tropics.