CASE PRESENTATION
A 40-year-old male with no prior medical history was hospitalized for 7
days due to (R) knee pain and swelling. Fever has been around for the
past two weeks, coming and going. The discomfort made it impossible for
him to walk. There were no gastrointestinal or genitourinary symptoms.
As well as unremarkable cardiopulmonary and neurological review. No
other joint involvement. No skin rashes and There was no history of
trauma. The patient stated that he had a similar episode of knee pain 10
years ago. He denied any contact with animals and no history of raw milk
consumption. His temperature was 37.8°C. The (R) knee was swollen, hot,
and tender with a limited range of movement (Figure1). The deferential
diagnosis included septic arthritis and crystal-induced arthritis. The
general examination was normal. Laboratory investigation showed White
Blood Count (WBC) of 5.2 and C-Reactive Protein (CRP) was high 110.
Hemoglobin (Hb) was 12.9, mean corpuscular volume (MCV) 60.9; red blood
cell distribution width (RDW) was 18.6, suggestive of iron deficiency
anemia. Platelets were normal at 270. The coagulation profile showed
high Prothrombin Time (PT) 12.8, international normalized ratio (INR),
and partial thromboplastin time (PTT) were normal. Blood chemistry
investigations were all normal. Brucella serology was done, which showed
Brucella IgG was positive 1: 320, and IgM was negative. Synovial fluid
aspirate revealed yellow, turbid fluid with WBCs of 4,800, red blood
cells (RBCs) 13,475, neutrophils 31.0, lymphocytes 2.0, and monocytes
67. Brucella melitensis was detected in both blood cultures and
synovial fluid. The echocardiogram did not reveal vegetation. Right knee
soft tissue ultrasound revealed large joint effusion reaching
suprapatellar bursa associated with synovial irregular thickening and
hypervascularity (Figure 2). The largest collection measuring 8.1x2.2
cm. Rifampicin, doxycycline, and gentamycin were started, and his
condition has improved.