A Patient with Brucella with initial Manifestations similar to Crimean Congo Fever

The unusual manifestations of brucellosis as an endemic disease involving multiple organ systems include headache, confusion, acute abdomen, psoas abscess, endocarditis, perinephric mass, insulin resistance, and cauda-equina syndrome. In this paper we report a patient with such situations that was initially diagnosed and treated for Crimean-Congo hemorrhagic fever (CCHF) with partial improvement of symptoms after Ribavirin therapy and readmission for brucellosis and improvement of symptoms after combination therapy for the later diagnosis. A 31-year-old male patient was attended with intermittent fever and chill plus myalgia, melena, and hematuria since one week ago. He had also generalized abdominal pain and loss of appetite with a body mass index of 19 kg/m². He had a history of ten neonatal deaths of livestock in the last month. In laboratory tests, the liver enzymes were raised and pancytopenia was present. Patient received therapeutic dose of Ribavirin plus Apotel and the general status were improved. After one month, the patient was readmitted for fever plus right hip and knee pain, and the brucella IgG was in borderline level (10.36). He received treatment for brucellosis including Amikacin, Doxycycline, and Rifampin. The Wright and Coomb's Wright tests were positive. The general health was improved and the patient was discharged with administration of Doxycycline 100 mg twice a day and Rifampin 600 mg once a day. Totally, according to the reported case, it should be emphasized that Ribavirin is effective in the treatment of brucellosis.