Brucellar Ovarian Abscess Presenting as a Complex Ovarian Cystic Lesion

Background: Ovarian involvement is a rare focal manifestation of brucellosis and may present a diagnostic challenge because of its nonspecific imaging appearance.

Case presentation: A previously healthy 38-year-old woman presented with a one-week history of high-grade fever, weight loss, and abdominal pain. Laboratory evaluation demonstrated thrombocytopenia and elevated hepatocellular and cholestatic liver enzymes. Her epidemiological history was notable for potential environmental exposure to livestock.

Contrast-enhanced computed tomography revealed hepatosplenomegaly and ovarian cystic lesions. Gynecological ultrasound demonstrated a complex bilocular ovarian cystic lesion with heterogeneous internal echogenicity. The leading imaging consideration was an ovarian abscess, with a complex ovarian cyst and, less likely, an ovarian neoplasm included in the differential diagnosis.

Computed tomography-guided aspiration of the complex ovarian lesion yielded thick purulent material. Cultures of both the aspirated material and blood grew Brucella species, confirming a brucellar ovarian abscess. Targeted antimicrobial therapy was initiated, followed by clinical improvement.

Conclusion: Brucellar ovarian abscess should be considered in a complex ovarian cystic lesion accompanied by systemic infection and relevant epidemiological exposure. Image-guided aspiration can establish the diagnosis, facilitate targeted treatment, and potentially avoid unnecessary surgery.