An Uncommon Case of Acute Brucellosis Presenting with Severe Thrombocytopenia

Abstract

A 49-year-old man was admitted to the hospital with complaints of fatigue, epistaxis and a skin rash. The whole blood count revealed isolated thrombocytopenia (4,000/mL), and the patient was admitted to the hematology department with a diagnosis of immune thrombocytopenia. He did not respond to steroid treatment for 15 days, and a subfebrile fever developed during this period. A diagnosis of acute brucellosis was considered due to positive serological tests and a blood culture positive for Brucella spp. After starting doxycycline and rifampicin therapy, the patient's thrombocyte count increased to 15,000/mL on the third day, to 41,000/mL on the sixth day and was normal on the 21st day of treatment. A diagnosis of brucellosis must be considered in patients presenting with severe and isolated thrombocytopenia in countries where brucellosis is endemic.

Egyptian Pediatric Guidelines for the Management of Children with Isolated Thrombocytopenia Using the Adapted ADAPTE Methodology—A Limited-Resource Country Perspective

“…Diagnosis of primary ITP is made when isolated thrombocytopenia occurs in the absence of identifiable and specific precipitants [25]. Differential diagnosis includes infectious, immunologic causes, hematologic, endocrine, and neoplastic causes [26][27][28][29][30].…”