BACKGROUND
Brucellosis is a globally prevalent zoonosis caused by bacteria of the genus Brucella. It poses a persistent clinical challenge due to its propensity for chronicity, high relapse rates, and substantial underreporting. This report describes the case of a 72-year-old male land surveyor with Hashimoto’s thyroiditis, a history of acute myocardial infarction, and type 2 diabetes mellitus who presented with chronic recurrent fever, orchiepididymitis, nasal ulcers, and skin rash due to brucellosis (undulant fever).
CASE REPORT
A 72-year-old male land surveyor with a decade-long history of recurrent fever, orchiepididymitis, and pulmonary granuloma developed acute fever, sweats, rash, and nasal crusting during hospitalization for myocardial infarction. Standard serological tests, blood cultures, and polymerase chain reaction assays were repeatedly negative during subsequent evaluation. A diagnosis of chronic-phase brucellosis was established based on occupational exposure to infected cattle (Brucella abortus), a historical reactive Rose Bengal test (1: 160), compatible clinical features, and systematic exclusion of alternative etiologies (vasculitis, tuberculosis, fungal infections, and endocarditis). Sustained remission was eventually achieved with an individualized 6-month empiric rescue regimen comprising 3 antimicrobial agents (doxycycline, rifampin, and ciprofloxacin). The patient completed 6 months of post-treatment follow-up without recurrence.
CONCLUSIONS
Establishing a diagnosis of chronic-phase brucellosis remains challenging when contemporaneous microbiological and serological assays are negative. In such contexts, a detailed occupational history, compatible clinical features, and systematic exclusion of alternative etiologies are critical to guide clinical management. Baseline endocrine comorbidities should be considered strictly as hypothesis-generating contextual factors, rather than established causal drivers of bacterial persistence.

Keywords: Brucellosis; Diabetes Mellitus, Type 1; Endocrine System Diseases; Hypothyroidism; Zoonoses