A male patient of 32 years was referred for surgical drainage and
orchidectomy of the right testis following a cycling injury. A
Venereal Disease Research Laboratory (VDRL) test was requested by the surgery department to rule out
secondary syphilis. Although serum samples gave a negative result in the VDRL test, qualitative screening was performed for Brucella
antibodies, as per hospital policy, since
brucellosis is endemic in this region. Following a positive reaction, a quantitative standard tube agglutination test was carried out yielding titres that were exceptionally high (STAT = 40 960 IU ml(-1); 2-ME = 1 : 5120). This finding correlated with the patient's history which included a number of predisposing factors for contracting
brucellosis including exposure to cattle, consumption of raw milk and assisting in the parturition of cattle. Consequently, surgery was postponed and treatment was changed from
injections of
ceftriaxone to the WHO regimen for the treatment of
brucellosis: 1 g
streptomycin once daily, administered intra-muscularly, plus 100 mg
doxycycline twice daily, taken orally. Following 3 days of this treatment, the testicular swelling reduced considerably and
orchidectomy was not required. Indeed, after a week, swelling was completely resolved and the patient was discharged. To our knowledge, this is the first case of such high titres in a patient as a result of epididymo-
orchitis without the typical clinical presentation of
fever and
joint pain that is normally associated with
brucellosis.