Atypical presentation of multifocal calcified brucellomas causing hepatic venous outflow obstruction: a case report

BackgroundBrucellosis, a zoonosis endemic to the Mediterranean, can rarely progress to chronic hepatosplenic suppurative complications. The imaging findings in this case-multiple hepatic abscesses with central calcifications and venous compression-deviate from the two primary hepatosplenic brucelloma patterns described in the literature: solitary calcified abscesses and diffuse miliary lesions. While solitary lesions are well-documented, multifocal abscesses with vascular complications, as observed here, are exceptionally rare.Case presentationWe report a 69-year-old man from rural Sicily, involved in the cheesemaking process using unpasteurized milk for personal consumption, presenting with 40 days of fever, malaise, and arthralgia. Initial investigations revealed elevated liver enzymes and ultrasound showing multiple hepatic lesions with hyperechoic calcifications ("snowflake" pattern). After referral to our tertiary center, contrast CT confirmed heterogeneous hypodense lesions, the largest compressing the inferior vena cava and hepatic veins. This manifestation deviates from the traditionally recognized "solitary abscess with calcification" and "miliary" patterns. CT-guided drainage yielded purulent material, but blood PCR identified Brucella melitensis, supported by IgG/IgM seropositivity. Chronic hepatosplenic brucellosis was diagnosed.ConclusionThis case highlights the importance of heightened clinical awareness, advanced imaging techniques, and a multidisciplinary approach in diagnosing and managing rare hepatic manifestations of brucellosis. The integration of interventional radiology significantly improves patient outcomes, especially in cases with complications such as venous compression.