Brucellosis-Induced Autoimmune Hemolytic Anemia Treated with Rituximab

Abstract

Novel therapeutic approaches with molecular agents such as rituximab may assist in treatment of considerably severe infectious pathogen-induced autoimmune hemolytic anemia that is refractory to first-line therapy.

Two Cases of Autoimmune Hemolytic Anemia Secondary to Brucellosis: A Review of Hemolytic Disorders in Patients with Brucellosis

“…Autoimmune hemolysis is a rare entity in patients with brucellosis, with only three cases published in the literature thus far (14)(15)(16). In the present report, we described two patients with Brucella melitensis who presented with direct antiglobulin test (DAT)-positive AIHA.…”

“…The development of hemolytic anemia during the course of brucellosis has often been described in the context of microangiopathy (6)(7)(8)(9)(10)(11)(12); however, autoimmune hemolytic anemia (AIHA) is a rare clinical presentation of this disease (14)(15)(16). We herein describe the cases of two patients with acute brucellosis who presented with Coombs-positive AIHA.…”

“…In the current medical literature, there are only three case reports of brucella-associated DAT-positive AIHA (14)(15)(16).…”

“…Treatment of AIHA and brucellosis: Among the published cases of AIHA and brucellosis, none of the patients received RBC transfusions (14)(15)(16). With respect to the treatment of Brucella-associated hematological disorders, one patient received high-dose methylprednisolone (HDMP), one patient received corticosteroids, IVIG and rituximab (RTX) and one patient received doxycycline alone.…”

Hematological findings in children with brucellosis

“…Hence, it presents difficulty in diagnosis because it mimics many other diseases. The disease also produces a variety of abnormalities in hematological parameters, including mostly leukopenia and mild anemia but, rarely, pancytopenia and thrombocytopenia . Furthermore, some cases of brucellosis with predominant hematological changes may mimic primary hematological disease …”