title: Spontaneous bacterial peritonitis by Brucella in a cirrhotic patient.
abstract: Spontaneous bacterial peritonitis (SBP) is a frequent form of decompensation of end-stage liver disease, with an incidence of 15-20% and a short-term mortality of 10-33%. The usual causative agents (90% of SBP) are enteric Gram-negative bacteria-Escherichia coli and Klebsiella pneumoniae. Brucella is known to be a possible, but exceedingly rare, causative agent of SBP. We present the case of a 47-year-old Egyptian man, with hepatitis C cirrhosis, and a 2 week history of ascites, jaundice, encephalopathy, fever and pain on his right shoulder that started while travelling in the Middle East. Laboratory and imaging studies were undertaken and he was diagnosed an SBP that failed to respond to Imipenem. Brucella was identified both in the ascitic fluid and blood; he was started on doxycycline plus rifampin with immediate clinical improvement. The antibiotic regimen was kept for 8 weeks. The patient is currently under evaluation for liver transplantation.
authors.affiliation: Department of Gastroenterology and Hepatology, Medical School of Lisbon, Hospital Santa Maria, Lisbon, Portugal. alex.fsof@gmail.com
authors.forename: Alexandre Oliveira
authors.initials: AO
authors.lastname: Ferreira
authors.forename: Luis Nogueira
authors.initials: LN
authors.lastname: Martins
authors.forename: Rui Tato
authors.initials: RT
authors.lastname: Marinho
authors.forename: José
authors.initials: J
authors.lastname: Velosa
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002002:Brucella / Q000302:isolation & purification*; D002006:Brucellosis / Q000175:diagnosis* / Q000188:drug therapy; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D004797:Enzyme-Linked Immunosorbent Assay; D006801:Humans; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents
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