The n e w e ng l a n d j o u r na l of m e dic i n e

TEACHING points

Presentation, Diagnosis, and Treatment of Brucellosis

• The differential diagnosis for liver lesions is broad and includes infectious,
neoplastic, and granulomatous diseases; substantial calcification of any such
lesion should prompt serious consideration of brucellosis, tuberculosis, and
histoplasmosis.

• Empirical management of liver abscess typically requires both drainage and

prolonged courses of antibiotics, but caution is warranted in aspiration or
drainage of such lesions if there is a high level of suspicion for echinococcus,
given the risks of seeding infection and inducing anaphylaxis.

• Brucellosis, a zoonotic infection that occurs in many parts of the world, can be
difficult to diagnose owing to its variable manifestations and timing relative to
exposure, as well as challenges in testing, including the relatively low sensitivity
of cultures and the limitations of serum agglutination testing. Consideration
should be given to 16S rRNA testing, which can be helpful in diagnosis.

• Treatment of brucellosis typically requires combination therapy, such as

doxycycline and rifampin, doxycycline and gentamicin, or ciprofloxacin and
rifampin, for a prolonged time. The decision regarding the choice of antibiotic
regimen should take into account the patient’s age, renal function, and any
coexisting conditions.

These teaching points are drawn from the Interactive Medical Case. For more information, see
Malishchak L, Vaidya A, Ostrominski J, Bry L, Maguire JH. A rocky resurgence. N Engl J Med
2023;388:e5