A multicenter retrospective study defining the clinical and hematological manifestations of brucellosis and pancytopenia in a large series: Hematological malignancies, the unusual cause of pancytopenia in patients with brucellosis

Abstract

The aim of the study is to review the clinical manifestations and the hematological findings of brucellosis and pancytopenia, with or without hematological malignancies. The records of 202 patients with brucellosis were evaluated retrospectively. Among these cases of brucellosis seen in a 6 year period between April 1999 and June 2005, 30 patients with pancytopenia were identified. The most common manifestation was fever, followed by weight loss, anorexia, malaise, arthralgia, and hepatosplenomegaly. Bone marrow biopsies revealed hypercellularity or normocellularity. The most common findings in the bone marrow evaluation were histiocytic hemophagocytosis and granulomas. Among all cases, we diagnosed 5 hematological malignancies (1 acute myelogenous leukemia, 2 acute lymphoblastic leukemia, and 2 multiple myeloma) concurrently with brucellosis. The clinical symptoms and findings were similar in patients with and without malignancies. In cases with malignancies, the bone marrow biopsy revealed predominant primary disease involvement. Significant increases in ESR and CRP, severe anemia and thrombocytopenia were observed in patients with malignancies. Peripheral blood counts in patients without malignancies returned to normal after antibiotic treatment for brucellosis. However, pancytopenia in two patients with malignancies did not recover because of primary resistant disease. We conclude that while histiocytic hemophagocytosis may be considered as a major cause of pancytopenia, leukemic infiltration can also be an extreme and unusual cause of pancytopenia in patients in whom brucellosis was concurrently diagnosed with hematological malignancies. Am. J. Hematol., 2008. © 2007 Wiley‐Liss, Inc.

Human brucellosis in a non-susceptible host: a case report

“…11 Common hematological manifestations include leucopenia, anemia and thrombocytopenia. 12 The standard treatment for human brucellosis is doxycycline, 100mg BD and rifampicin 600-900mg once a day for 6 consecutive weeks. A combination of doxycycline and gentamycin is also preferred.…”

Clinical human brucellosis in Malaysia: a case report

“…Ocular manifestations include optic neuritis, papilledema and uveitis [19] . Common hematologic findings include leukopenia, anemia, and thrombocytopenia [20] .…”

“…Nevertheless, studies have shown seropositive humans in Malaysia, mainly among veterinarians and farmers associated with occupational exposure to animals. The seroprevalent was mainly males (90%) within the age range between 20 and 45 years old [10] . This paper reports a case of human brucellosis involving a laboratory assistant in Malaysia.…”

Brucellosis in Immunocompromised Hosts

“…In patients with malignant and pre-malignant hematological disorders living in endemic areas, brucellosis can cause: febrile illnesses; pancytopenia; systemic infections including endocarditis, meningoencephalitis, pulmonary insufficiency and splenic abscess; complicated bacteremia and serious morbidity [61,99,[106][107][108][109]150,151] Additionally, several cases of febrile neutropenia caused by infection with Brucella species have been reported in patients with malignant hematological disorders living in geographic locations that are endemic for brucellosis [147][148][149][152][153][154][155][156]. Brucellosis may develop at presentation of the hematological malignancy or even if the disease is under control [99,150,151].…”

“…Hematological abnormalities in brucellosis include: leukopenia with relative lymphocytosis, neutropenia, anemia, thrombocytopenia, pancytopenia, DIC, microangiopathic hemolytic anemia (MAHA), hypersplenism, and elevation of ESR as well as CRP [1,61,189,190]. However, none of these hematological abnormalities is specific or characteristic for brucellosis [190].…”