We describe the case of a 37-year-old man with a previous active life who reported osteoarticular pain of variable location in the last month and fever in the last week with peaks (morning and evening) of 40 C in the last 24-48 hours, for which he went to the Emergency Department. Before the onset of the symptoms, he had been in Extremadura in a brucella-endemic region, eating unpasteurised goat's milk and cheese from such cattle. Several cases of brucellosis were found among the diners. During admission for the study of the febrile syndrome with epidemiological antecedents of possible exposure to Brucella, the patient presented a picture of right orchiepididymitis.
Physical examination revealed: temperature 40.2°C; T.A: 109/68 mmHg; Fc: 105 bpm. He was conscious, oriented, sweating, eupneic, with good nutritional and hydration status. No palpable head and neck lymph nodes, no goitre or jugular vein engorgement, with symmetrical carotid pulses. Cardiac auscultation rhythmic, without murmurs, friction or extratonos. Pulmonary auscultation with preservation of vesicular murmur. Abdomen soft, depressible, without masses or megaliths. In the neurological examination, no meningeal signs or signs of focality were detected. Extremities without varicose veins or oedema. Peripheral pulses present and symmetrical. The urological examination revealed an enlarged right teste, not adhered to the skin, with areas of fluctuation and intensely painful on palpation, with loss of the epididymo-testicular boundary and positive transillumination.
The analytical data showed the following results: haemogram: Hb 13.7 g/dl; leucocytes 14,610/mm3 (neutrophils 77%); platelets 206,000/mm3. ESR: 40 mm 1 hour. Coagulation: TQ 87%; TTPA 25.8 sec. Biochemistry: glucose 117 mg/dl; urea 29 mg/dl; creatinine 0.9 mg/dl; sodium 136 mEq/l; potassium 3.6 mEq/l; GOT 11 U/l; GPT 24 U/l; GGT 34 U/l; alkaline phosphatase 136 U/l; calcium 8.3 mg/dl. Urine: sediment normal.
During admission, blood cultures were requested: positive for Brucella and specific serology for Brucella: Rose Bengal +++; Coombs test > 1/1280; Brucellacapt > 1/5120. The imaging tests requested (chest X-ray, abdominal ultrasound, cranial CT scan, transthoracic echocardiogram) showed no significant pathology, except for the testicular ultrasound, which showed thickening of the scrotal sac with a small amount of fluid with septa and an enlarged testicle with small hypoechoic areas inside that may represent microabscesses.
With the diagnosis of orchiepididymitis secondary to Brucella, symptomatic treatment (antipyretics, anti-inflammatory drugs, rest and testicular elevation) and specific antibiotic treatment was started: Doxycycline 100 mg orally every 12 hours (for 6 weeks) and Streptomycin 1 gram intramuscularly every 24 hours (for 3 weeks). The patient's condition improved significantly after one week of hospitalisation, and he was discharged home, where he completed the antibiotic treatment regimen. Subsequent visits to the clinic showed complete remission of the symptoms.