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Bruzellose mit tödlichem Endotoxinschock

Brucellosis with lethal endotoxic shock

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Zusammenfassung

□ Hintergrund

Die Bruzellose ist eine Zoonose mit guter Prognose bei frühzeitiger Diagnose. Die Diagnosestellung bereitet jedoch auch heute noch Schwierigkeiten.

□ Eigene Beobachtung

Ein 60jähriger Metzger kam mit undulierendem Fieber, Schweißausbrüchen, Arthralgien und Gewichtsverlust zur stationären Aufnahme. Die weiteren Untersuchungen zeigten eine Hepatosplenomegalie mit laborchemischen Zeichen einer Hepatitis. Im Abdomensonogramm sowie-CT wurden Leberrundherde nachgewiesen, die histologisch Granulomen mit zum Teil zentraler Nekrose entsprachen. Durch den Erregernachweis in der Blutkultur nach verlängerter Bebrütung wurde die Diagnose einer Bruzellose gestellt. In den ersten 24 Stunden nach Beginn einer resistenzgerechten Behandlung mit Tetracyclinen und Gyrasehemmern trat ein Endotoxinschock auf, und der Patient verstarb im Multiorganversagen bei disseminierter intravasaler Gerinnung.

□ Schlußfolgerung

Bei Patienten mit undulierendem Fieber und Leberbeteiligung soll die Bruzellose in die differentialdiagnostischen Überlegungen miteinbezogen werden. Eine gute Zusammenarbeit zwischen Klinikern, Pathologen und Mikrobiologen ist notwendig, um eine frühe und korrekte Diagnose zu stellen. Dies ist der erste Fallbericht mit letalem Ausgang eines Endotoxinschocks bei Bruzellose.

Summary

□ Background

Brucellosis is a zoonosis with good prognosis in cases of early diagnosis. To make the diagnosis is still a problem today.

□ Case Report

A 60-year-old butcher was admitted with undulating fever, sweats, arthralgia and weight loss. Further examination revealed hepatosplenomegaly with laboratory findings of a hepatitis and multiple focal liver lesions shown by abdominal ultrasound and CT. Histologically, these lesions corresponded to caseous granulomas. Diagnosis of brucellosis was confirmed by detection of brucella species in prolonged incubation in blood culture. After the beginning of antibiotic resistence-tested therapy with tetracycline and quinolones, an endotoxic shock occurred during the first 24 hours of treatment and the patient died after multiorgan failure with disseminated intravascular coagulation.

□ Conclusion

In cases of undulating fever with liver involvement, a brucellosis should be considered. Good teamwork of the internal, pathological and microbiological departments is necessary for early and correct diagnosis. This is the first report of human brucellosis in association with lethal endotoxic shock.

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Authors and Affiliations

  1. Medizinische Klinik C, Klinikum Ludwigshafen, Bremserstraße 79, D-67063, Ludwigshafen

    Stephan Kress & Jürgen Ferdinand Riemann

  2. Medizinische Klinik A, Klinikum Ludwigshafen, Ludwigshafen, Deutschland

    Pieter Klooker & Horst Brass

  3. Pathologisches Institut, Klinikum Ludwigshafen, Ludwigshafen, Deutschland

    Volker Kaufmann

  4. Mikrobiologisches Institut, Klinikum Ludwigshafen, Ludwigshafen, Deutschland

    Norbert Sloot

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Kress, S., Klooker, P., Kaufmann, V. et al. Bruzellose mit tödlichem Endotoxinschock. Med. Klin. 92, 561–566 (1997). https://doi.org/10.1007/BF03044933

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