Could it be Brucella melitensis? Recognizing and managing a rare pathogen in periprosthetic infections.

Periprosthetic joint infections caused by Brucella melitensis are rare and present significant diagnostic and therapeutic challenges, especially in endemic regions such as Anatolia. The indolent nature of Brucella infections often results in subclinical presentations, complicating early detection and management. This case series highlights the importance of recognizing Brucella melitensis as a potential pathogen in periprosthetic joint infection and explores the treatment options for this condition. Herein, we present five cases of Brucella melitensis-associated periprosthetic joint infections involving three hip replacements and two knee replacements. Diagnoses were confirmed through advanced diagnostic techniques, including prolonged cultures and serological testing, as routine methods often yielded negative results. Two patients underwent one-stage revision arthroplasty, two underwent two-stage revision arthroplasty, and one patient was managed conservatively with targeted antibiotics due to the absence of prosthetic loosening. All patients showed excellent functional recovery and infection eradication at follow-up, with normalized inflammatory markers and no evidence of recurrence. This case series emphasizes the importance of clinical suspicion and the use of advanced diagnostics in endemic areas for timely recognition of Brucella-associated periprosthetic joint infections. One-stage revision arthroplasty combined with prolonged antibiotic therapy demonstrated favorable outcomes and may serve as an effective treatment strategy.