Background <p>Tissue infarction is a rare but serious life-threatening complication of brucellosis. In this systematic review, we investigated manifestations, diagnostic and therapeutic measures, and causes of tissue infarction in patients with brucellosis.</p> Methods <p>Pubmed/Medline, Embase, Scopus, and Web of Science were systematically searched for case reports or case series that detail tissue infarction secondary to brucellosis up to October 20, 2024. Baseline characteristics, clinical and paraclinical findings, infarcted tissue details, treatments, and outcomes of the patients were independently extracted by two reviewers.</p> Results <p>A total of 34 articles were included, reporting on 36 brucellosis patients with tissue infarction in the central nervous system (CNS) (<i>n</i> = 24), spleen (<i>n</i> = 6), heart (<i>n</i> = 3), kidney (<i>n</i> = 1), bowel (<i>n</i> = 1), and three organs–spleen-bowel-kidney– (<i>n</i> = 1). These patients primarily presented with flu-like symptoms and organ-specific manifestations resulting from tissue infarction. Laboratory findings were predominantly suggestive of brucellosis. Furthermore, tissue infarctions were confirmed by imaging in all cases. Most patients indicated improvement with medications and surgical interventions.</p> Conclusion <p>Tissue infarction in patients with brucellosis can impact various organs, particularly the brain, spleen, and heart, with symptoms differing based on the specific organ involved. As patients with brucellosis exhibit symptoms of tissue infarction, healthcare providers should be aware of this complication. Prompt diagnosis can be achieved through laboratory and imaging investigations. Appropriate medical and surgical treatments should be provided for these cases.</p> Trial registration <p>The study protocol was registered in the international prospective registry of systematic reviews known as PROSPERO (Protocol number: CRD42024595263).</p>