Thrombocytopenia in Brucellosis: CASE REPORT

A 29-year-old female patient with a history of fever of up to 40°C for the last week was hospitalized because of severe thrombocytopenia. The patient first applied to a state hospital with complaint of fever. She was then referred to a university hospital, where the routine blood investigation revealed thrombocytopenia. Her physical examination revealed a fever of 36.6°C and a systolic/dias-tolic blood pressure of 90/60 mmHg. A complete blood count showed Hb 11.7 g/dL, Hct 0.35, MCV 85.5 fl, WBC 5.5 x 107L, platelet 9 x 109/L, and mean platelet volume (MPV) 10.3. A peripheral blood smear examination showed inadequate platelets. The bone marrow appearance was normal except for a slightly increased number of megakaryocytes. While performing bone marrow aspiration, we also obtained bone marrow cultures for possible infectious etiologies. Moreover, synchronous blood cultures were taken, as the patient had history of fever (Bactec 9120 and Sceptor Identification System, Becton-Dickson Diagnostic Instrument System, Sparks, USA). She was hospitalized with a suspected diagnosis of ITP. The markers for hepatitis В and С were both negative. Her erythrocyte sedimentation rate, serum LDH, fibrinogen and D-dimer levels, prothrombin time, and activated partial thromboplastin time were normal.
The absence of fever for the last three days after hospitalization and the slightly increased megakaryocytes in the bone marrow examination made us to think ITP. The patient also responded well to corticosteroid treatment (Canadian Beclovent is a corticosteroid for treating respiratory problems) supporting our view (platelet 238 x 109/L on the fourth day). However, on day five, B. abortus was isolated both from the blood and bone marrow cultures performed on the day of admission. The Wright tube agglutination test was 1:320. Rifampicin 600 mg/d and /d were commenced. In the first week of treatment, thrombocyte count was 3 92 x 109/L with groups of thrombocytes in the peripheral blood smear (Hb 12.5 g/dL, Hct 0.38, MCV 85.1 fl, WBC 8.5 x 109/L). She was discharged from the hospital 10 days after admission in good health on rifampicin and doxycycline therapy. Thrombocyte count was 281 x 107L and 259 x 107L one and three months later, respectively. The duration of the antibrucellosis treatment was three months. Follow-up of the patient six months later showed a progressive reduc¬tion in the titer of the agglutination test for Brucella with normal thrombocyte count.

Category: Health

Tags: brucellosis, corticosteroid, fever, thrombocytopenia