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Institute for Medical Microbiology and Epidemiology of Infectious Diseases, Leipzig University Hospital, Liebigstraße 21, D-04103 Leipzig, GermanyInterdisciplinary Center for Infectious Diseases, Leipzig University Hospital, Liebigstraße 21, D-04103 Leipzig, Germany
Institute for Medical Microbiology and Epidemiology of Infectious Diseases, Leipzig University Hospital, Liebigstraße 21, D-04103 Leipzig, GermanyInterdisciplinary Center for Infectious Diseases, Leipzig University Hospital, Liebigstraße 21, D-04103 Leipzig, Germany
Institute for Medical Microbiology and Epidemiology of Infectious Diseases, Leipzig University Hospital, Liebigstraße 21, D-04103 Leipzig, GermanyInterdisciplinary Center for Infectious Diseases, Leipzig University Hospital, Liebigstraße 21, D-04103 Leipzig, Germany
Interdisciplinary Center for Infectious Diseases, Leipzig University Hospital, Liebigstraße 21, D-04103 Leipzig, GermanyDivision of Infectious Diseases and Tropical Medicine, Department of Gastroenterology and Rheumatology, Leipzig University Hospital, Liebigstraße 20, D-04103 Leipzig, Germany
A 27-year old microbiologist developed rash, chills, sweating, fatigue, joint pain, nosebleed, headache and undulating fever. Two months ago, he accidently got exposed to Brucella melitensis cultures. Inflammation parameters and aminotransferases were moderately elevated. Serological tests showed presence of Brucella specific antibodies, and Brucella melitensis was cultured from blood. An acute brucellosis as a laboratory infection was diagnosed. This infection route is feared in microbiological laboratories because the airborne infection dose of Brucella cultures is extremely low (
). Three days after initiation of antibiotic treatment with doxycycline and rifampicin, the patient presented at the emergency room with a dull retrosternal pain and cold sweat. Laboratory parameters revealed a strongly elevated troponin T level (1246 pg/ml). Chest X-ray, electrocardiogram and echocardiography were unsuspicious. Contrast-enhanced cardiac MRI revealed a marked subepicardial hyperintensity in T2 weighted imaging compatible with edema (Figure 1) and a pattern of myocardial delayed enhancement in the mid anterolateral wall (Figure 2), thus indicating a myocarditis suspected of Brucella. This potentially lethal complication is highly rare, particularly in the absence of simultaneous endocarditis (
Due to the myocardial complication, gentamicin was added for 10 days along with a prolonged, 12-week antibiotic therapy with doxycycline and rifampicin, although the evidence for this enforcement of antibiotic therapy is sparse (
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