Brucella Melitensis As Causative Agent for Neck Abscess in an Endemic Area

BACKGROUND: Brucellosis, a zoonotic disease, is very common in the Mediterranean basin and a major concern in livestock areas. We present a rare case of a Brucella-caused abscess in the neck of a stock-breeder in an endemic Greek area. CASE REPORT: A 39-year-old male, living in the rural area of Thessaly, presented with a mass in the left area of his neck. Clinical examination and imaging tests revealed an abscess in the left sternocleidomastoid muscle. Sampling of the abscess by fine-needle aspiration yielded inflammatory fluid (17x10(3) cells/μL). Molecular sequencing (16S rRNA polymerase chain reaction) performed directly in the clinical sample identified the presence of Brucella melitensis within 24 hours after material sampling. The microorganism was isolated in agar media four days later. The Rose-Bengal test was negative, while the Brucellacapt test showed titer 1/320. Given the results obtained with these molecular techniques, the patient was offered treatment with streptomycin (1 g for 3 weeks) and oral doxycycline (100 mg twice daily for 6 weeks), concurrently. CONCLUSION: In areas endemic for brucellosis, the investigation of a patient with a neck abscess should include Brucella spp. among possible causative agents.