Brucellosis presenting with sepsis and cholestasis: A rare presentation of an endemic disease with review of the literature

Brucellosis is a zoonotic disease endemic to the Middle East and Mediterranean basin. It has gained diagnostic challenge recently due to its increasingly non-specific and vague manifestations at presentation. Here, we report a 53-year-old man presenting with undulating fever and shaking chills and frequency, dysuria, hesitancy and malodorous urine. He had prior complicated urinary tract infection treated with intravenous antibiotics. Further evaluation revealed negative urine culture, intra-hepatic cholestasis due to underlying infection, elevated acute phase reactants and pancytopenia.The diagnosis of brucella was established as blood cultures grew Brucella melitensis and serum serology for Brucellosis returned positive. Following initiation of anti- brucella drugs, fever and laboratory abnormalities gradually returned to normal. Brucellosis should be always considered in the differential diagnosis of patients presenting with sepsis in endemic regions or when empiric antibiotic therapy fails to improve clinical and laboratory abnormalities. Diagnosis requires high level of suspicious based on the clinical history and constellation of symptoms.