Successful Conservative Management of Complicated Brucella Endocarditis

Abstract

Brucella endocarditis (BE) is a rare but life-threatening complication of brucellosis and remains the principal cause of disease-related mortality. Prosthetic-valve involvement is exceptionally uncommon and is usually managed with combined medical and surgical therapy because of the high risk of abscess formation and embolic complications. We report a 51-year-old man with a bioprosthetic aortic valve who presented with recurrent fever, weight loss, and acute neurological deficits following previously treated, culture-confirmed brucellosis related to consumption of unpasteurized goat milk. Diagnostic evaluation revealed an embolic ischemic stroke, prosthetic-valve vegetation complicated by a paravalvular aortic-root abscess, rising Brucella melitensis serological titers despite negative blood cultures, and concomitant brucellar spondylitis. A diagnosis of prosthetic-valve BE with systemic dissemination was established. Although urgent surgical intervention was recommended, the patient declined surgery and was treated conservatively with prolonged combination antimicrobial therapy. The outcome was favorable, with complete clinical recovery, significant neurological improvement, normalization of inflammatory markers, and complete echocardiographic resolution of vegetation and abscess while preserving ventricular function. This case supports the potential role of individualized conservative management in selected patients with complicated BE.