A rare complication in humans of a rare disease in Germany: A case of bilateral Brucella tubo-ovarian abscesses

Brucellosis, caused by the gram-negative bacterium Brucella spp. (B. melitensis, B. abortus, B. suis or B. canis) is a neglected zoonotic disease. The global number of human cases is underestimated due to the lack of comprehensive surveillance systems in endemic regions. In Germany, brucellosis is a notifiable disease and case counts are stable at low level with around 30 to 40 cases per year. Almost all cases are imported from endemic regions like in the Mediterranean basin and the Middle East.

The different Brucella spp. are pathogenic for a wide variety of animals and a typical infection localization are the reproductive organs (both in female and male animals). In humans, involvement of the female genito-urinary system is rare and only a few case reports are available from literature. Here, we report of a bilateral Brucella tubo-ovarian abscess with infection spread to the appendix in a 29-year-old Bosnian woman. Two years after the first diagnosis of brucellosis she suffered from abdominal pain and undulating high fever. Ultrasound and a MR scan showed extensive tubo-ovarian abscesses. Explorative laparoscopy was performed and confirmed bilateral tubo-ovarian abscesses with a dermoid cyst located at the right ovary. Additionally, a severe peritonitis and a secondary phlegmonous appendicitis were observed. An appendectomy and bilateral ovarian cystectomy were performed. Brucella melitensis was cultured from specimens collected during surgery and confirmed by PCR and whole genome sequencing.

Our report discusses the lessons learned from this rare complication of brucellosis in a non-endemic region and includes a detailed molecular epidemiological analysis of the strain.