# Discitis, Diabetes, and Endocarditis: A Challenging Clinical Triad

## TL;DR

A diabetic farmer in India was misdiagnosed with tuberculosis but later found to have brucellosis with severe complications, highlighting the difficulty in diagnosing zoonotic infections.

## Contribution

The paper presents a rare case of brucellosis with concurrent endocarditis and spondylodiscitis, emphasizing diagnostic challenges in endemic regions.

## Key findings

- The patient's symptoms worsened despite antitubercular therapy, leading to a revised diagnosis of brucellosis.
- Brucellosis was confirmed through serological and imaging findings, along with occupational livestock exposure.
- The case underscores the need to consider zoonotic infections in atypical presentations in endemic areas.

## Abstract

A 58-year-old male farmer from southern India with a history of diabetes mellitus presented with a one-year history of fever and progressive lower back pain. He was initiated on antitubercular therapy (ATT) for suspected tuberculous spondylitis. Despite three months of ATT, his symptoms worsened, with progressive constitutional symptoms and features of heart failure. Further evaluation revealed aortic valve vegetation and persistent lumbar spondylodiscitis. Serological and imaging findings, along with occupational exposure to livestock, led to a diagnosis of brucellosis with infective endocarditis and spondylodiscitis. The patient’s condition deteriorated despite supportive care and antibiotics as per treatment guidelines. This case highlights the diagnostic challenges of brucellosis in endemic regions and underscores the importance of considering zoonotic infections in patients with atypical presentations of spondylodiscitis and endocarditis, in regions where both tuberculosis and brucellosis are endemic.