brucellosis is a systemic infection that may affect any organ or system of the human body . usually , a slight increase in the liver function tests and mild hepatosplenomegaly occur , and sometimes , acute hepatitis develops , but hepatic abscess is a rare manifestation of that disease 1 , 2 , 3 . a 33yearold woman was admitted to our university hospital with the complaints of temperature up to 40c , headache , nausea , and weakness for 2 weeks . she had a history of raising livestock and lived in rural area . on physical examination the laboratory data were as follows : total leukocyte count , 5600/mm ( 400010,000/mm ) ; differential leukocyte count : neutrophils , 54% ; lymphocytes , 36% ; monocytes , 8% ; basophils , 0.3% ; eosinophils , 1.7% ; platelets , 285,000/mm ( normal range : 150,000450,000/mm ) ; hemoglobin , 12 g / dl ; hematocrit , 36.6% ; serum alanine transferase ( alt ) , 242 u / l ( rr 035 iu / l ) ; serum aspartate transferase ( ast ) , 162 u / l ( rr 032 iu / l ) ; serum glutamyl transpeptidase ( gtp ) , 60 u / l ( rr 040 iu / l ) ; alkaline phosphatase ( alp ) , 95 iu / ml ( rr 35114 iu / l ) ; total bilirubin , 0.4 mg / dl ( rr 01.2 mg / dl ) ; sedimentation rate , 17 mm / h ; and creactive protein , 11.3 mg / l ( rr 05 mg viral hepatitis markers ( the hbsag , antihbc igm , antihav igm , and antihcv tests ) were negative . abdominal ultrasonography showed multiple small echogenic foci are more prominent in the right lobe of the liver ( fig . 1).with these findings , the patient was diagnosed as having hepatic microabscesses due to brucellosis . doxycycline ( 2  100 mg / day p.o . ) and rifampicin ( 1  600 mg / day p.o . ) the patient received this treatment for 3 months . on the fiftyninth day of the treatment , the levels of serum alanine transferase level and serum aspartate transferase decreased to the reference range . brucellosis is a zoonosis that has been virtually eliminated from most developed countries , but it is still endemic in many regions of the world including mediterranean areas , in parts of south and central america , and east and western africa . the disease is transmitted to man mainly after consumption of contaminated unpasteurized milk and dairy products and less often after direct contact with infected animals 1 . hepatic involvement in brucellosis covers a wide spectrum , ranging from mild elevation of aminotransferases to hepatitis including granulomatous forms and to liver abscesses . increases in aminotransferases are noted in onefourth to onethird of brucellosis cases and are more frequent in the acute stages . hepatic involvement in brucellosis has been reported in the literature in around 23% of the cases . although b. abortus tends to establish a granulomatous form of hepatitis , b. melitensis may cause both diffuse and granulomatous lesions in the liver 1 , 2 , 3 , 4 . an abscess caused by brucella spp usually represents the chronic form of disease , but it can occur in acute or subacute brucellosis . routine laboratory findings in brucellosis are not usually diagnostic that may include leukopenia , anemia , thrombocytopenia , pancytopenia , and mildtomoderate elevation of liver function tests 2 , 5 , 6 . ultrasonography most commonly shows a single , hypoechoic lesion with 1 centrally located calcium deposits . computed tomography findings most commonly depict a hypodense area , and often one or more saccular , loculated , heterogeneous mass , and one or more calcifications 5 , 6 . the diagnosis of brucellosis can be established according to the isolation of brucella spp . in blood , bone marrow or any other body fluid or tissue sample , or the presence of a compatible clinical picture with the demonstration of specific antibodies at significant titers or seroconversion . significant titers are considered to be a standard agglutination test ( sat ) result 1/160 or a coombs antibrucella or immunocapture agglutination test result 1/320 1 , 6 . the best regimen for the treatment of localized lesions has not been clearly defined . the duration of treatment varies depending on the individual case and the response to treatment 1 . small , multifocal abscesses which can be detected in the acute forms of the disease respond very well to medical treatment . other types of abscesses with an indolent course have a much worse prognosis , which considered to be a true focal complications of the disease . however , no clear distinction is made of these groups 7 . in this case , the short duration of symptoms and the high titer of brucella agglutination test suggest that this case was acute . it was identified multiple millimetric foci were more prominent in the right lobe of the liver parenchyma to be significant in terms of microabscesses . our patient was successfully treated with a combination of doxycycline and rifampicin for 3 months . the diagnosis of brucellosis in our case was confirmed with clinical findings , livestock farming history , positive serological tests , and complete response to medical treatment . in conclusion , brucellosis is a systemic infectious disease and it is still an important public health problem in endemic areas of the world including turkey that can cause serious complications and significant morbidity . clinicians should be considered in the differential diagnosis of this unusual complication of brucellosis for those who live in or have visited endemic areas . ie , rka , oo , pod , and ss : performed the analysis of case data . all authors : contributed toward data analysis , drafting and critically revising the manuscript , and agree to be accountable for all aspects of the manuscript .
key clinical messagehepatic abscess due to brucella species is an extremely rare complication especially in acute illness . here 
 , we report a case of hepatic microabscesses probably caused by brucella in a 33yearold woman with acute infection who was successfully treated with a combination of doxycycline and rifampicin for 3 months .