Atypical pulmonary manifestation of brucellosis in a non-endemic region: case report from Slovakia

Abstract

Brucellosis is a zoonotic infection with diverse clinical manifestations. Pulmonary involvement is rare—occurring in less than 1% of cases—and typically limited to endemic regions. In Slovakia, where brucellosis is non-endemic, human cases are exceptional. We present a rare and severe respiratory form of brucellosis in a patient with occupational exposure to livestock. We describe a 40-year-old female dairy farm worker admitted with fever, chills, and dyspnea. Initial workup revealed mild laboratory abnormalities and chest infiltrates. Despite empirical antibiotics, her condition rapidly progressed to acute respiratory distress syndrome (ARDS), acute kidney injury, and septic shock. Mechanical ventilation and vasopressor support were required. Serological testing confirmed Brucella abortus infection. Antibiotic therapy was escalated to tigecycline and meropenem, with subsequent clinical improvement. Follow-up imaging showed significant regression of pulmonary infiltrates. The patient completed a six-week course of doxycycline and fully recovered. This case underlines the importance of considering brucellosis in febrile patients with livestock exposure, even in non-endemic settings. Severe pulmonary forms are rare but life-threatening. Early recognition, targeted antibiotic therapy, and multidisciplinary care are critical for favorable outcomes. Pulmonary brucellosis is rare (< 1% of cases) but can be life-threatening, even in non-endemic regions. Occupational exposure to livestock is the primary risk factor in non-endemic settings such as Slovakia. Tigecycline is a viable alternative in complicated brucellosis with renal failure due to its non-renal elimination. Multidisciplinary care and dynamic serological monitoring were crucial for successful patient management.