Akademik Veri Yönetim Sistemi
23rd Annual Conference of APASL, Brisbane, Avustralya, 12 - 15 Mart 2014, sa.341, ss.4, (Özet Bildiri)
Introduction: Brucellosis is a zoonotic disease that persists and
replicates within phagocytic cells of the reticuloendothelial system.
Brucellosis is endemic in Turkey. Despite the high prevalence of bone
marrow suppression, clinical hepatitis and hemaphagocytic syndrome
due to involvement of RES is rare.
Case report: A twenty-seven years old, male patient without any
known disease with fever, malaise, generalized body pain complaints
for two months admitted to our hospital. Because of additional
symptoms like nausea, vomiting, cough and weight loss (5 kg), the
patient was hospitalized. On physical examination; his body temperature
fever 39.5 C, pulse 114/minute, blood pressure 110/70
mmHg. His liver was palpable one cm under his rib and Castell’s sign
on traube’s space was positive. Blood Laboratory parameters were
found as follows: white blood cells 1240/mm3; neutrophil 650/mm3;
platelet 54,000/mm3; hemoglobin 11.6 mg/dL; CRP 16.06 mg/dL;
sedimentation 6 mm/h; ALT 79 U/L; AST 177 U/L; ALP 139 U/L;
GGT 245 U/L; T. Bilirubin 1.99 mg/dL; D. Bilirubin 1.55 mg/dL;
LDH 2111 U/L; PT 15.9 sn; aPTz 41.5 sn; INR 1.4. His complete
urine analysis parameters were found as follows: protein 150 mg/dL;
urobilinogen 12 mg/dL; bilirubin 3 mg/dL. Findings of abdominal
ultrasound were plastering style fluid in the right perirenal region,
minimally free fluid in the pelvis as well as hepatosplenomegaly and
perihepatitis. On his serological tests only HAV IgG was positive. His
serology was negative for hepatitis B, hepatitis C, syphilis, HIV,
EBV, CMV. Meanwhile his Rose Bengal test was found to be positive,
the standard Wright 1/640 positive, 2 Mercapto Ethanol 1/160
positive, Brucella IgM was positive (10:48), and Brucella IgG was
negative. Than doxycycline 100 mg q12h PO, rifampicin 600 mg
q24h PO and ciprofloxacin 750 mg q12h PO treatment was started. But,
treatment was stopped because of higher levels of AST(573 U/L),ALT
(256 U/L), ALP (201 U/L), GGT (378 U/L) and triple therapy treatment
was stopped. New treatment with gentamicin 160 mg q24h IV and
ceftriaxone 1 g q12h IV was started. Fresh frozen plasma was given for
four days with INR follow-up. Hematology consultation and bone
marrow biopsy were performed due to progression of neutropenia (336/
mm3) and thrombocytopenia (27,400/mm3).There was increased
megakaryocytes, conglomeration dysmegakaryopoiesis and small
conglomerations of histiocyte groups in aspiration material. Also
increased histiocytes, macrophages which fagocytosing thrombocytes,
erythrocytes and erythroblasts, prominent decreased erythrocyte series
with 2–3 % blasts were seen in aspiration film and touch imprint. With
these findings, patient was codiagnosed as hemophagocytic syndrome.
Intraveno¨z immunglobuline treatment (400 mg/kg/day) was implemented
for five days. Erythrocyte suspensions were given during
hemoglobin level follow up the fourth day of IVIG treatment the
patient’s neutropenic state recovered; liver enzyme levels normalized
on the 11th day of treatment and triple brucellosis treatment was started
again. Due to improvement of the patient’s clinical symptoms, treatment
was continued for three months.
Conclusion: Brucellosis can mimic many diseases. Persistent
thrombocytopenia, decreased hemoglobin should be considered in
patients with hemophagocytic syndrome and IVIG treatment should
be administered in the early period.