Background <p><i>Brucella spp</i>. infection of the aorta and large vessels is rare, but can be life-threatening. Complications of this infection include the formation of a fistula. The objective was to identify published cases of <i>Brucella spp</i>. aortitis with fistula formation in the gastrointestinal or respiratory tract as a complication, as well as to determine whether these patients differ from those without fistula formation.</p> Methods <p>A systematic review of the scientific literature was conducted, involving a search of MEDLINE, Scopus, and Web of Science for all published cases, and an examination of their clinical and epidemiological characteristics.</p> Results <p>Ten published cases were identified, although one article could not be retrieved. Therefore, nine cases were analyzed. All patients were men, with a mean age of 60.6 years, and with an epidemiological history of exposure. The fistulas found were aorto-esophageal (3), aorto-bronchial (3), aorto-duodenal (3), and aorto-enteric (1). In addition to the general manifestations of brucellosis, patients may also present with hemoptysis, hematemesis, or melena. Unlike most cases of aortitis caused by <i>Brucella spp</i>., the most common location is the descending thoracic aorta (55.6%). Computed tomography (CT) is the most commonly used imaging test, but it does not always visualize the fistula, which has been demonstrated surgically in some cases. Treatment is typically achieved with surgery and antimicrobial agents against <i>Brucella spp</i>., although the optimal treatment course and duration remain unknown.</p> Conclusions <p>Fistulization to the gastrointestinal or respiratory tract in brucellar aortitis is rare but a potentially important complication. It is not always detected on imaging tests. The most common location is the descending thoracic aorta.</p>