FASCIITIS-PANNICULITIS IN ACUTE BRUCELLOSIS

A 25-year-old woman villager, who previously enjoyed good health, was hospitalized 2 weeks after she first noticed malaise, fever, and bilat eral calf swelling. Two days prior to admission, her 3-year-old son wa s hospitalized with a febrile illness in the Department of Pediatrics. A tube agglutination titer of 1/320 and, later, blood cultures positi ve for Brucella melitensis established the diagnosis of brucellosis. T he patient conceded to her family's habit of drinking unpasteurized go at milk. Except for hepatosplenomegaly and bilateral calf swelling, ph ysical examination was unrewarding. Leukopenia with relative lymphocyt osis was found. Initially, Brucella antibodies were undetectable. The tube agglutination test, repeated 10 days later, was positive for Bruc ella melitensis at a titer of 1/80. Doxicillin and rifampin treatment was begun. The distal thirds of the calves were swollen. While the col or and temperature of the skin were normal, the subcutaneous layers at these sites were indurated; the skin fold measured 5 cm (Fig. 1). The proximal border of the swelling was well demarcated, while the distal aspect merged imperceptibly with the normal integument of the foot. T he histologic changes of a full thickness biopsy were confined to the subcutis and fascia, the skin and muscle being normal. The subcutaneou s septa and fascia were fibrotically thickened and contained sparsely scattered lymphoyctes. The fat tissue lobules were heavily infiltrated by lymphocytes admixed with few histiocytes and plasma cells (Fig. 2) . There were some small and irregularly shaped foci of necrosis in the fat tissue. Following initiation of antibiotic medication, defeveresc ence occurred within a week and the subcutaneous induration progressiv ely diminished. No residual changes were palpated after 6 weeks, at th e termination of treatment.