Please cite this article: Hussain B, Sultan F. A rare cardiac manifestation of Brucellosis. J Rare Cardiovasc Dis. 2017; 3(4): xx–xx; doi: http://dx.doi.org/10.20418%2Fjrcd.vol3no4.289 Confict of interest: none declared. Submitted: May 15, 2017. Accepted: August 2, 2017. * Corresponding author: Cardiology section, Department of Medicine, Aga Khan University Hospital, Stadium Road, P.O. Box 3500, Karachi 74 800, Pakistan; tel.: +92 21 3486 4700, fax: +92 21 3493 4294, 3493 2095;; email: bilal_observer@hotmail.com Copyright © 2017 Journal of Rare Cardiovascular Diseases; Fundacja Dla Serca w Krakowie A rare cardiac manifestation of Brucellosis (RCD code: VIII) Bilal Hussain*, Fateh Ali Tipoo Sultan Cardiology section, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan CASE REPORT Rare diseases of the heart Journal of Rare Cardiovascular Diseases 2017; 3 (4): 129–132 www.jrcd.eu Background Brucellosis should always be considered as a diferential diagnosis in patients presenting with chronic fever, with a history of contact with animals or animal products. Tough endocarditis is a rec‑ ognized complication of brucellosis, constrictive pericarditis is rarely associated with Brucella infections. Te diagnosis of peri‑ cardial constriction can be done by visualization of characteristic features on 2D echocardiogram or cardiac magnetic resonance imaging (CMR) by ofering a 3D image of the heart can confrm the echo fndings. Treatment of pericardial involvement in such cases is centered upon the surgical excision of pericardium along with long duration of antibiotic therapy. Case presentation A 36 year‑old married gentleman, school teacher from a country‑ side presented with symptoms of dyspnea, generalized weakness and low‑grade fever for the past two years. Te symptoms of dys‑ pnea had worsened over the last six months with rapid weight loss of 10 kg over this period. Tere was no relevant family history of heart disease. He denied any instance of unprotected sexual contact or previous exposure to individuals with tuberculosis. Tere was also no history of sub‑ stance abuse. However, he had a history of drinking goat’s and cow’s milk which he had raised. Te patient had received treatment at a rural health centre with analgesics and empiric oral antibiotics, and then was referred for further investigation due to persistent symptoms. On clinical examination the patient had a low‑grade fever, bilat‑ eral pedal oedema, jugular venous distention and ascites. He was hemodynamically stable. Based on the history and examination a diagnosis of right heart failure was formulated. Te patient was referred for an electrocardiogram (ECG) and transthoracic echo‑ cardiography (TTE). Te ECG showed normal sinus rhythm with infrequent atrial premature complexes and T‑wave inversions (Figure 1). TTE showed a thick and shiny pericardium with normal lef ventricular systolic function. Prominent septal bounce and signifcant respi‑ Abstract Brucellosis, a zoonosis caused by Gram‑negative coccobacilli Brucella, is characterized by a systemic illness with vague symptoms. Though, cardiac involvement with Brucella is reported mostly as endocarditis, the occurrence of exclusive Brucella constrictive pericar‑ ditis without endocardium involvement is extremely rare. We report a case of a young patient from a countryside, who presented with low‑grade fever, dyspnea and malaise with signs of right heart failure. He was diagnosed with constrictive pericarditis on 2‑D echocar‑ diogram and the diagnosis was confrmed by cardiac magnetic resonance. Pericardiectomy was performed to relieve pericardial con‑ striction. The patient, however, continued to have low‑grade fever and lethargy. A workup for chronic infections revealed strongly posi‑ tive titers for Brucella, indicating that the patient was sufering from systemic brucellosis. The patient was treated with combination of antibiotics for six weeks and responded well to the treatment. The case highlights the fact that brucellosis has a wide array of clinical presentations and may present as an isolated exclusive constrictive pericarditis. The diagnosis of brucellosis should always be considered in patients presenting with chronic fever and a history of animal contact. JRCD 2017; 3 (4): 129–132 Key words: brucellosis, constrictive pericarditis, cardiac magnetic resonance imaging