[A case of brucella endocarditis in Tunisia].

Brucella endocarditis (BE) is a rare but serious complication of brucellosis and is the leading cause of death from this infection. It is often difficult to diagnose due to its non-specific symptoms and low prevalence. This clinical case concerns a 59-year-old man with a mechanical aortic prosthesis who presented with heart failure with prosthetic disconnection, aortic annulus abscess, and negative blood cultures. The diagnosis was confirmed by serologic testing and culture of the surgical specimen, which revealed infection with B. melitensis associated with consumption of unpasteurized raw milk. Treatment required surgery to replace the prosthesis and drain the abscess, and prolonged antibiotic therapy with doxycycline, cotrimoxazole, and rifampicin. Despite postoperative complications, hemodynamic and infectious outcomes were favorable. This case highlights the importance of a multidisciplinary approach, including targeted serologic testing and cardiac imaging, for early diagnosis. It also emphasizes the need for surgical management combined with appropriate antibiotic therapy to improve the prognosis of patients with BE.