{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T06:16:11Z","timestamp":1778134571688,"version":"3.51.4"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T00:00:00Z","timestamp":1778112000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>\n                    Pulmonary brucellosis is a rare focal manifestation of human brucellosis with non-specific clinical features. Predominant imaging findings include pneumonia, pleural effusion, pulmonary nodules, abscesses, and interstitial changes. Multiple cavitary lesions are exceptionally rare. Herein, we report a case of bilateral multiple pulmonary cavities in a 76-year-old man with a 2-year history of intermittent cough, sputum production, and progressive dyspnea that acutely worsened 10 days prior to admission with intermittent fever, anorexia, and fatigue. Chest computed tomography (CT) revealed bilateral upper lobe irregular mass-like opacities and multiple nodules with heterogeneous density, punctate calcifications, and cavitation; multiple microcavitations in the right middle and lower lobes and the left lower lobe; and enlarged, calcified hilar and mediastinal lymph nodes. Metagenomic next-generation sequencing of bronchoalveolar lavage fluid identified\n                    <jats:italic>Brucella<\/jats:italic>\n                    species, which was confirmed by positive serology. After 3 days of doxycycline (0.1 g bid po) and rifampicin (0.6 g qd po), followed by 140 days of doxycycline (0.1 g bid po), rifapentine (0.6 g biw po), and levofloxacin (0.5 g qd po), along with silibinin meglumine tablets 0.1 g tid po for hepatoprotective therapy, the patient became afebrile with significant symptomatic improvement. Repeat chest CT demonstrated reduction in the right upper lobe consolidation\/cavity and left upper lobe consolidation, resolution of the right lower lobe cavity, and complete resolution of the microcavitations. This case underscores that pulmonary brucellosis should be considered in the differential diagnosis of cavitary lung lesions in patients with livestock exposure and that prolonged combination antibiotic therapy can achieve favorable clinical and radiological outcomes.\n                  <\/jats:p>","DOI":"10.3389\/fmed.2026.1814731","type":"journal-article","created":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T05:42:49Z","timestamp":1778132569000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Pulmonary brucellosis presenting as multiple cavitary lung lesions on imaging"],"prefix":"10.3389","volume":"13","author":[{"given":"Tong","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, Lanzhou University, Lanzhou","place":["Gansu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Min","family":"Wang","sequence":"additional","affiliation":[{"name":"Xincheng Hospital, Jiuquan Branch of Shanghai General Hospital, Jiuquan","place":["Gansu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li","family":"Zhao","sequence":"additional","affiliation":[{"name":"Xincheng Hospital, Jiuquan Branch of Shanghai General Hospital, Jiuquan","place":["Gansu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guoke","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lili","family":"Hou","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]},{"name":"Department of Respiratory and Critical Care Medicine, Jiuquan Branch of Shanghai General Hospital, Jiuquan","place":["Gansu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,7]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"82","DOI":"10.3390\/pathogens12010082","article-title":"Determination of virulence-associated genes and antimicrobial resistance profiles in Brucella isolates recovered from humans and animals in Iran using NGS technology.","volume":"12","author":"Dadar","year":"2023","journal-title":"Pathogens."},{"key":"B2","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1016\/S1473-3099(06)70382-6","article-title":"The new global map of human brucellosis.","volume":"6","author":"Pappas","year":"2006","journal-title":"Lancet Infect Dis."},{"key":"B3","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1016\/j.micinf.2018.06.001","article-title":"Zoonoses under our noses.","volume":"21","author":"Cross","year":"2019","journal-title":"Microbes Infect."},{"key":"B4","doi-asserted-by":"publisher","first-page":"6091","DOI":"10.2147\/JMDH.S536880","article-title":"Multimodal magnetic resonance imaging and radiomics in Brucella spondylitis: diagnostic applications and differential diagnosis.","volume":"18","author":"Wu","year":"2025","journal-title":"J Multidiscip Healthc."},{"key":"B5","doi-asserted-by":"publisher","first-page":"104782","DOI":"10.1016\/j.amsu.2022.104782","article-title":"Spinal brucellosis causing spondylodiscitis.","volume":"82","author":"Ali Adam","year":"2022","journal-title":"Ann Med Surg."},{"key":"B6","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1080\/14787210.2017.1254042","article-title":"Treatment of pulmonary brucellosis: a systematic review.","volume":"15","author":"Solera","year":"2017","journal-title":"Expert Rev Anti Infect Ther."},{"key":"B7","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1378\/chest.13-0240","article-title":"Respiratory system involvement in brucellosis: the results of the Kardelen study.","volume":"145","author":"Erdem","year":"2014","journal-title":"Chest."},{"key":"B8","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1128\/CMR.00060-07","article-title":"Cavitary pulmonary disease.","volume":"21","author":"Gadkowski","year":"2008","journal-title":"Clin Microbiol Rev."},{"key":"B9","doi-asserted-by":"publisher","first-page":"e70387","DOI":"10.1002\/ccr3.70387","article-title":"Brucella pneumonia mimicking pulmonary tuberculosis: a case report.","volume":"13","author":"Chapra","year":"2025","journal-title":"Clin Case Rep."},{"key":"B10","doi-asserted-by":"publisher","first-page":"e329","DOI":"10.1097\/INF.0000000000004845","article-title":"Diagnostic value of cerebrospinal fluid metagenomics next-generation sequencing in neurobrucellosis in children.","volume":"44","author":"Zhu","year":"2025","journal-title":"Pediatr Infect Dis J."},{"key":"B11","doi-asserted-by":"publisher","first-page":"2327","DOI":"10.1002\/jor.25867","article-title":"Study on the value of second-generation sequencing technology in the clinical diagnosis of osteoarticular brucellosis.","volume":"42","author":"Yao","year":"2024","journal-title":"J Orthop Res."},{"key":"B12","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1093\/clinchem\/hvab173","article-title":"The role of metagenomics and next-generation sequencing in infectious disease diagnosis.","volume":"68","author":"Miller","year":"2021","journal-title":"Clin Chem."},{"key":"B13","doi-asserted-by":"publisher","first-page":"102679","DOI":"10.1016\/j.tmaid.2023.102679","article-title":"Chest CT findings in community-acquired pneumonia due to Coxiella burnetii (Q fever) compared to Streptococcus pneumoniae, a cross sectional study in French Guiana, 2013-2017.","volume":"57","author":"de La Porte des Vaux","year":"2024","journal-title":"Travel Med Infect Dis."},{"key":"B14","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1186\/s41479-017-0035-0","article-title":"Necrotizing pneumonia: an emerging problem in children?","volume":"9","author":"Masters","year":"2017","journal-title":"Pneumonia."},{"key":"B15","doi-asserted-by":"publisher","first-page":"4740","DOI":"10.1177\/0300060518799879","article-title":"Immune response and differentially expressed proteins in the lung tissue of BALB\/c mice challenged by aerosolized Brucella melitensis 5.","volume":"46","author":"Fu","year":"2018","journal-title":"J Int Med Res."},{"key":"B16","doi-asserted-by":"publisher","first-page":"661","DOI":"10.12138\/j.issn.1671-9638.20245429","article-title":"Diagnosis and treatment scheme for Brucellosis (2023 Edition).","volume":"23","year":"2024","journal-title":"Chinese J Infect Control."},{"key":"B17","doi-asserted-by":"publisher","first-page":"1458316","DOI":"10.3389\/fcimb.2024.1458316","article-title":"Application of metagenomic next-generation sequencing in the diagnosis of infectious diseases.","volume":"14","author":"Zhao","year":"2024","journal-title":"Front Cell Infect Microbiol."},{"key":"B18","doi-asserted-by":"publisher","first-page":"1570776","DOI":"10.3389\/fcimb.2025.1570776","article-title":"Pathogen detection and antibiotic use in granulomatous lobular mastitis: a comparison of mNGS and culture.","volume":"15","author":"Mu","year":"2025","journal-title":"Front Cell Infect Microbiol."},{"key":"B19","doi-asserted-by":"publisher","first-page":"923341","DOI":"10.3389\/fimmu.2022.923341","article-title":"Case report: suspected case of brucella-associated immune reconstitution inflammatory syndrome.","volume":"13","author":"Qu","year":"2022","journal-title":"Front Immunol."},{"key":"B20","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1016\/s0163-4453(98)90647-8","article-title":"Paediatric neurobrucellosis: case report and literature review.","volume":"37","author":"Habeeb","year":"1998","journal-title":"J Infect."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1814731\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T05:43:12Z","timestamp":1778132592000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1814731\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,7]]},"references-count":20,"alternative-id":["10.3389\/fmed.2026.1814731"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1814731","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,7]]},"article-number":"1814731"}}