Brucellosis Infection- A Leukaemia Mimic
Dear Editor, Brucellosis is multi-systemic infection with varied clinical presentation. Hematological manifestation of brucella includes, anaemia, thrombocytopenia, and pancytopenia with hepatosplenomegaly, lymphadenopathy which can be misdiagnosed as leukaemia. A 65-year-old male patient, who has...
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| Format: | Article |
| Language: | English |
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JCDR Research and Publications Private Limited
2023-01-01
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| Series: | Journal of Clinical and Diagnostic Research |
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| Online Access: | https://www.jcdr.net/articles/PDF/17436/59878_final_F(KM)_PF1(AKA_SHU)_PN(SHU).pdf |
| _version_ | 1797936118239330304 |
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| author | Santosh Govind Rathod Sauliha Yaseen |
| author_facet | Santosh Govind Rathod Sauliha Yaseen |
| author_sort | Santosh Govind Rathod |
| collection | DOAJ |
| description | Dear Editor,
Brucellosis is multi-systemic infection with varied clinical presentation. Hematological manifestation of brucella includes, anaemia, thrombocytopenia, and pancytopenia with hepatosplenomegaly, lymphadenopathy which can be misdiagnosed as leukaemia. A 65-year-old male patient, who has been complaining for a month of fever, nocturnal sweats, widespread weakness, and abdominal pain. The patient was known to have hypertension and was on tablet Amlodipine 5 mg once day for past three years. The family history was not significant. A clinical examination revealed hepatosplenomegaly and anaemia (Hb 8.7 g/dL) (organs palpable 4 cm and 5 cm below the costal margins respectively) Leucopenia (1×109/L) was detected in the laboratory tests (neutrophils 33%, lymphocytes 60%, monocytes 5%, eosinophils and basophils 0%). Human Immunodeficiency Virus (HIV) and hepatitis B and C were ruled out by serological assays (HIV). The Antinuclear Antibody (ANA), anti-double stranded Deoxyribonucleic Acid (antidsDNA), direct and indirect Coombs tests returned negative results. Epstein-Barr virus and Cytomegalovirus (CMV) serological tests came out negative. The serological test for enteric fever came back negative, A bone marrow aspiration was done because of his ongoing cytopenia and fever, and the results revealed trilineage hyperplasia with the left shift. Due to the persistent clinical symptoms (mainly fever), the patient was interviewed again and then his profession was revealed to be a sheep herder. Thus, a provisional diagnosis of brucellosis was considered. The serological test for brucellosis sent. Brucella abortus and Brucella melitensis both had titers of >1:640 and C- reactive protein was >6 mg/mL. The blood cultures showed Gram-negative cocci growth and after fifteen days confirmed the abortus, melitensis. Thus, a diagnosis of brucella infection was finalized.
The World Health Organization suggests a six-week course of
doxycycline and rifampin medication for six weeks, as in present
case, patient had treatment with Doxycycline 100 mg BD and
Rifampicin 600 mg OD [1]. The patient was admitted for one week in
our ward, and his hemogram showed improvement with treatment.
After one month of treatment, his counts became normal, showing
White Blood Cells (WBC) 6.5×109/L, hemoglobin (Hb) 12.5 g/dL,
Mean Corpuscular Volume (MCV) 90 fl, platelets 213×109/l, and
the size of his spleen and liver shrank. The fever went away, and his
follow-up was still positive. The most prevalent zoonotic disease worldwide is human
brucellosis. The Gram-negative coccobacillus Brucella is the culprit.
In the Middle East, sub-Saharan Africa, India, and Central and South
America, brucellosis is a major cause of morbidity and mortality [2,3].
Humans in endemic nations are typically exposed to the disease
through eating tainted meats and unpasteurized dairy products. It
primarily presents as an occupational danger in wealthy nations.
Night sweats, myalgia, malaise, protracted, undulating fevers,
and hepatosplenomegaly are all symptoms of brucellosis [4,5]. It
primarily affects the reticuloendothelial system more than other
tissues. The infection also affects other organ, heart, central nervous
system, kidneys, genitourinary, cardiovascular, gastrointestinal,
and cardiovascular system. In one of Turkish study of 484 cases
of brucellosis, anaemia, thrombocytopenia, and leucopenia seen
in 21.5%, 18.8%, 14.5% respectively. Pancytopenia observed
in 2-14% patients. Lymphadenopathies are found in 10%-20%
patients of brucellosis, and cervical lymph node is commonly
affected [4,5]. There are no disease specific findings to differentiate
between brucellosis induced cytopenia from non-infectious causes,
and therefore, brucellosis infection misdiagnosed as leukaemia,
lymphoma [5,6]. All these cytopenia and lymphadenopathy due to
brucellosis infection responds very well to treatment.
In an endemic location, a thorough patient history aids in the early
identification and treatment of the patient. When a patient exhibits
hepatosplenomegaly, pancytopenia, and fever, it is important to
consider the differential diagnosis of brucellosis. |
| first_indexed | 2024-04-10T18:24:46Z |
| format | Article |
| id | doaj.art-9d530f3283f54f2090b1502bbd7a8047 |
| institution | Directory Open Access Journal |
| issn | 2249-782X 0973-709X |
| language | English |
| last_indexed | 2024-04-10T18:24:46Z |
| publishDate | 2023-01-01 |
| publisher | JCDR Research and Publications Private Limited |
| record_format | Article |
| series | Journal of Clinical and Diagnostic Research |
| spelling | doaj.art-9d530f3283f54f2090b1502bbd7a80472023-02-02T06:08:41ZengJCDR Research and Publications Private LimitedJournal of Clinical and Diagnostic Research2249-782X0973-709X2023-01-01171OL0110.7860/JCDR/2023/59878.17436Brucellosis Infection- A Leukaemia MimicSantosh Govind Rathod0Sauliha Yaseen1Senior Resident, Department of Clinical Haematology, Shere-I Kashmir Institute of Medical Sciences, Sringar, Jammu and Kashmir, India.Senior Resident, Department of Anaesthesiology, Shere-I Kashmir Institute of Medical Sciences, Sringar, Jammu and Kashmir, India.Dear Editor, Brucellosis is multi-systemic infection with varied clinical presentation. Hematological manifestation of brucella includes, anaemia, thrombocytopenia, and pancytopenia with hepatosplenomegaly, lymphadenopathy which can be misdiagnosed as leukaemia. A 65-year-old male patient, who has been complaining for a month of fever, nocturnal sweats, widespread weakness, and abdominal pain. The patient was known to have hypertension and was on tablet Amlodipine 5 mg once day for past three years. The family history was not significant. A clinical examination revealed hepatosplenomegaly and anaemia (Hb 8.7 g/dL) (organs palpable 4 cm and 5 cm below the costal margins respectively) Leucopenia (1×109/L) was detected in the laboratory tests (neutrophils 33%, lymphocytes 60%, monocytes 5%, eosinophils and basophils 0%). Human Immunodeficiency Virus (HIV) and hepatitis B and C were ruled out by serological assays (HIV). The Antinuclear Antibody (ANA), anti-double stranded Deoxyribonucleic Acid (antidsDNA), direct and indirect Coombs tests returned negative results. Epstein-Barr virus and Cytomegalovirus (CMV) serological tests came out negative. The serological test for enteric fever came back negative, A bone marrow aspiration was done because of his ongoing cytopenia and fever, and the results revealed trilineage hyperplasia with the left shift. Due to the persistent clinical symptoms (mainly fever), the patient was interviewed again and then his profession was revealed to be a sheep herder. Thus, a provisional diagnosis of brucellosis was considered. The serological test for brucellosis sent. Brucella abortus and Brucella melitensis both had titers of >1:640 and C- reactive protein was >6 mg/mL. The blood cultures showed Gram-negative cocci growth and after fifteen days confirmed the abortus, melitensis. Thus, a diagnosis of brucella infection was finalized. The World Health Organization suggests a six-week course of doxycycline and rifampin medication for six weeks, as in present case, patient had treatment with Doxycycline 100 mg BD and Rifampicin 600 mg OD [1]. The patient was admitted for one week in our ward, and his hemogram showed improvement with treatment. After one month of treatment, his counts became normal, showing White Blood Cells (WBC) 6.5×109/L, hemoglobin (Hb) 12.5 g/dL, Mean Corpuscular Volume (MCV) 90 fl, platelets 213×109/l, and the size of his spleen and liver shrank. The fever went away, and his follow-up was still positive. The most prevalent zoonotic disease worldwide is human brucellosis. The Gram-negative coccobacillus Brucella is the culprit. In the Middle East, sub-Saharan Africa, India, and Central and South America, brucellosis is a major cause of morbidity and mortality [2,3]. Humans in endemic nations are typically exposed to the disease through eating tainted meats and unpasteurized dairy products. It primarily presents as an occupational danger in wealthy nations. Night sweats, myalgia, malaise, protracted, undulating fevers, and hepatosplenomegaly are all symptoms of brucellosis [4,5]. It primarily affects the reticuloendothelial system more than other tissues. The infection also affects other organ, heart, central nervous system, kidneys, genitourinary, cardiovascular, gastrointestinal, and cardiovascular system. In one of Turkish study of 484 cases of brucellosis, anaemia, thrombocytopenia, and leucopenia seen in 21.5%, 18.8%, 14.5% respectively. Pancytopenia observed in 2-14% patients. Lymphadenopathies are found in 10%-20% patients of brucellosis, and cervical lymph node is commonly affected [4,5]. There are no disease specific findings to differentiate between brucellosis induced cytopenia from non-infectious causes, and therefore, brucellosis infection misdiagnosed as leukaemia, lymphoma [5,6]. All these cytopenia and lymphadenopathy due to brucellosis infection responds very well to treatment. In an endemic location, a thorough patient history aids in the early identification and treatment of the patient. When a patient exhibits hepatosplenomegaly, pancytopenia, and fever, it is important to consider the differential diagnosis of brucellosis.https://www.jcdr.net/articles/PDF/17436/59878_final_F(KM)_PF1(AKA_SHU)_PN(SHU).pdfanaemiahepatosplenomegalythrombocytopenia |
| spellingShingle | Santosh Govind Rathod Sauliha Yaseen Brucellosis Infection- A Leukaemia Mimic Journal of Clinical and Diagnostic Research anaemia hepatosplenomegaly thrombocytopenia |
| title | Brucellosis Infection- A Leukaemia Mimic |
| title_full | Brucellosis Infection- A Leukaemia Mimic |
| title_fullStr | Brucellosis Infection- A Leukaemia Mimic |
| title_full_unstemmed | Brucellosis Infection- A Leukaemia Mimic |
| title_short | Brucellosis Infection- A Leukaemia Mimic |
| title_sort | brucellosis infection a leukaemia mimic |
| topic | anaemia hepatosplenomegaly thrombocytopenia |
| url | https://www.jcdr.net/articles/PDF/17436/59878_final_F(KM)_PF1(AKA_SHU)_PN(SHU).pdf |
| work_keys_str_mv | AT santoshgovindrathod brucellosisinfectionaleukaemiamimic AT saulihayaseen brucellosisinfectionaleukaemiamimic |