Successful management of native-valve Brucella endocarditis with medical therapy alone

A 71-year-old Asian-Indian male agriculturist presented with fever since 3 months. Clinical examination revealed hepatosplenomegaly and an early diastolic murmur in the aortic area. Echocardiography confirmed aortic regurgitation with large vegetations on the aortic valve leaflets, and also showed mild left ventricular dilatation with systolic dysfunction. Although blood cultures were persistently sterile, serology for Brucella was strongly positive. On retrospective questioning, the patient confirmed frequent occupational exposure to cattle. Surgical intervention was offered, but refused by the patient on financial grounds. Medical therapy for brucellosis with rifampicin, doxycycline and streptomycin resulted in complete and durable recovery.