A healthy 23-year-old man with fever and a tender mass in his right anterior neck was found to have a branchial cleft cyst infected with Bordetella bronchiseptica. Initial testing suggested a Brucella species, but further laboratory testing identified the organism definitively. B. bronchiseptica infection in healthy adults is an unusual event.
CASE REPORTA previously healthy 23-year-old man was admitted to our hospital with a fever of 39°C (102°F) and a tender mass in his right anterior neck. The patient initially noted a small, painless swelling in his right neck 10 days prior to presentation. Over the ensuing week, the mass progressively enlarged, becoming increasingly erythematous and tender, and the patient noted daily spiking fevers. An immigrant from rural Mexico, he had been living in the United States for 6 months, working on a farm in central Pennsylvania as a mushroom collector. He reported no sick contacts. There were numerous goats, dogs, and cats on the farm, but he denied having been bitten or scratched by any of them. He denied having consumed unpasteurized dairy products.Physical examination revealed a young, thin male in no acute distress. He was normotensive, with a temperature of 39.1°C (102.2°F) on admission. The right anterior neck mass measured 2 by 4 cm and was firm, tender, and nonmobile. The skin overlying the mass was warm and erythematous. No draining sinus or fistula was present, and he had no associated lymphadenopathy or rashes. The remainder of his exam was unremarkable.The patient had an elevated white blood cell count of 13,200/ l, with 78% polymorphonuclear leukocytes. Tests of liver function were normal, and 2 sets of blood cultures showed no growth. A rapid plasma reagin test was negative, and tests for human immunodeficiency virus were nonreactive. The patient's chest radiograph was normal. A computed tomographic scan of the neck showed a 2.5-by 4.5-cm multilocular, necrotic mass in the right neck with associated induration of the adjacent soft tissues and deviation of the trachea (Fig. 1). No lymphadenopathy was present.Fine-needle aspiration of the mass was performed, the material was stained with Papanicolaou stain, and numerous neutrophils and squamous epithelial cells were evident. The large number of squamous epithelial cells in the aspirate confirmed the presence of a branchial cleft cyst. Acid-fast bacilli were not seen by Kinyoun staining of the specimen. Gram staining of the aspirate showed leukocytes with intracellular, pleomorphic, gram-negative coccobacilli. Based on this Gram stain and the patient's history of animal exposures, a presumptive diagnosis of brucellosis was made. The patient was subsequently begun on intravenous doxycycline and rifampin.A sample of the aspirate was inoculated onto blood, chocolate, and brucella agar plates and incubated at 37°C in an atmosphere of 5 to 10% carbon dioxide for 5 days. Multiple translucent, spheroidal colonies approximately 2 to 3 mm in diameter were isolated. The isolate was positive in tests for catalase, oxidase, an...