Infective endocarditis caused by Brucella melitensis: a case report highlighting the importance of history taking and laboratory analysis

We present a case of Brucella endocarditis in a 13 year old patient with known aortic stenosis. She was admitted to the National Heart Institute/Institut Jantung Negara, Malaysia with complains of fever, pain and swelling of left knee. Transthoracic echocardiography and transesophageal echocardiography showed no evidence of vegetations on the aortic valve. Differential diagnosis was made based on clinical manifestations, positive serology tests and isolation of Brucella melitensis from blood culture. The patient has a history of consumption of unpasteurised goat's milk prior to clinical symptoms. Although rare, the case emphasize that Brucella could be a potential complication of infective endocarditis (IE) involving patient who consumed unpasteurised goat's milk. The diagnosis of bacterial endocarditis based on clinical findings and supported by laboratory results has led to the appropriate treatment of this patient. To the best of our knowledge, this is the first case reported for Brucella endocarditis in Malaysia.