Brucella endocarditis is a rare manifestation of brucellosis, though it is endemic in some regions.2
Medical treatment for brucella endocarditis is not sufficient to cure the illness and successful management requires a combination of medical treatment and early surgery.3
Classically, brucellosis is treated with a combination of either doxycycline and streptomycin or doxycycline and rifampicin for four to six weeks. Longer regimens have been used in combination with surgery if endocarditis is present.2,3
There is no consensus on the optimal duration. Recently, fluoroquinolones have also been used to treat brucellosis.3
Three to five per cent of patients with infective endocarditis with common microorganisms develop a splenic abscess.4
However, to our knowledge, our case is the second to be reported in the literature of brucella endocarditis with splenic abscess.
Although splenic defects can be identified by ultrasonography and computed tomography, these tests cannot discriminate between abscess and infarct. Persistent fever and progressive enlargement of the lesion suggest that it is an abscess. Successful treatment of a splenic abscess generally requires drainage through a percutaneous approach if feasible. Splenic abscess should be effectively treated before surgery.4
All patients with endocarditis, abdominal complaints, and recurrent or persistent fever should be evaluated for any potential foci for relapse, particularly the spleen.