Brucellosis with hepatobiliary and pulmonary involvement: A case series of similar clinical patterns from a resource-limited setting

Brucellosis is a zoonotic disease with diverse and often misleading clinical presentations, including hepatobiliary and, less commonly, pulmonary involvement. In this case series, we discuss three patients presenting with complex hepatobiliary infections and pulmonary symptoms, initially misdiagnosed and treated as acute abdomen. Each patient exhibited a history of contact with cattle, abdominal pain, jaundice and systemic symptoms and required prolonged antibiotic courses due to persistent infection with diagnostic dilemma and slow clinical improvement. Diagnosis was a challenge due to negative conventional cultures and serology, necessitating empirical treatment based on clinical suspicion. In endemic regions like Sri Lanka, the lack of advanced diagnostics and the overlapping symptoms of brucellosis with other diseases mandate the need for increased clinical awareness and clinical pattern recognition, especially in resource-limited settings. These cases illustrate the importance of considering brucellosis in patients with prolonged fever, hepatobiliary symptoms and atypical pulmonary involvement. Early recognition of the clinical imprint of the disease can improve outcomes and potentially avoid unnecessary surgical interventions. Prevention measures are necessary to eliminate the spread.