Case Report: Lower back pain revealing a hidden gynecologic infection: Brucella melitensis superinfection of a giant ovarian cyst—a case report from Palestine

Introduction Human brucellosis is a multisystem disease with a broad clinical presentation caused by Brucella species. It commonly presents with nonspecific symptoms that may overlap the manifestations of other diseases. Genitourinary involvement occurs in approximately 10% of cases. Case presentation An 18-year-old female presented with severe lower back pain associated with fever, chills, nausea, and night sweats. In addition to constipation, myalgia, arthralgia, and menstrual irregularities. Notably, she reported a history of unpasteurized dairy products one month prior to symptom onset. Abdominal examination revealed right lower quadrant and suprapubic tenderness with a large palpable abdominal mass. Accompanied by thoracolumbar and lumbosacral tenderness. Intervention and outcome The patient underwent a left ovarian cystectomy via mini-laparotomy. Histopathological examination revealed a benign serous cystadenoma, while the cultures of blood and cystic fluid were positive for Brucella species, confirming superinfection of the cyst. She demonstrated marked clinical improvement following anti-brucellar treatment and surgical intervention. Conclusion This report highlights the importance of considering atypical presentations of a common infectious disease, brucellosis, in endemic regions. It underscores the value of comprehensive clinical assessment and meticulous history-taking in recognizing unusual disease manifestations, thereby facilitating timely diagnosis and reducing the risk of diagnostic delay.