title: [Brucellosis with fatal endotoxic shock].
abstract: BACKGROUND
  Brucellosis is a zoonosis with good prognosis in cases of early diagnosis. To make the diagnosis is still a problem today.
  
  
  METHODS
  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 resistance-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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Medizinische Klinik C, Klinikum Ludwigshafen.
authors.forename: S
authors.initials: S
authors.lastname: Kress
authors.forename: P
authors.initials: P
authors.lastname: Klooker
authors.forename: V
authors.initials: V
authors.lastname: Kaufmann
authors.forename: N
authors.initials: N
authors.lastname: Sloot
authors.forename: J F
authors.initials: JF
authors.lastname: Riemann
authors.forename: H
authors.initials: H
authors.lastname: Brass
mesh_terms: D001707:Biopsy, Needle; D002006:Brucellosis / Q000473:pathology*; D004211:Disseminated Intravascular Coagulation / Q000473:pathology; D017809:Fatal Outcome; D006801:Humans; D008099:Liver / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000473:pathology; D009784:Occupational Diseases / Q000473:pathology*; D012772:Shock, Septic / Q000473:pathology*