Hemophagocytic Syndrome in a Child with Brucellosis

Abstract

The authors report case of a two and half years old female child presented with fever for one month with hepatosplenomegaly. Though the child had been symptomatic for a prolonged period, she did not appear very unwell at presentation. However, after admission there was sudden rapid deterioration of her clinical status. Investigations revealed hemophagocytosis with brucella infection.

Hemophagocytic Lymphohistiocytosis Disease Mimic Due to Brucellosis

“…The umbrella term would include: 6 HLH disease: Patients who would benefit from HLH-specific therapies HLH disease mimics: Patients in whom distinctive immune dysregulation is not the core problem and thus would not benefit from immune suppression but rather treatment of the underlying condition A PubMed search and review of case reports of pediatric brucellosis and HLH in the literature mainly occur in areas of the world where brucella is endemic or in patients who recently visited such areas (Table 2). [7][8][9][10][11][12][13][14][15][16][17] Many of these patients underwent invasive procedures (such as bone marrow biopsy) to complete HLH evaluation, and some received HLH-directed treatment, despite most patients improving quickly on antibiotics alone. We believe that in those cases where brucella and HLH disease mimics are suspected, a cautious approach should be taken, and invasive procedures and HLH-directed treatment should be deferred if the patient remains stable.…”

Secondary haemophagocytic lymphohistiocytosis in a child with brucellosis

“…Similarily El-Amin et al also reported cure rate of 90% with combination of rifampicin and co-trimoxazole for6weeks. 14,15…”

Brucellosis as a cause of hyperferritinemia in systemic arthritis

“…Brucellosis is a common infection in Saudi Arabia due to ingestion of fresh dairy products. It has been reported to result in hyperferritinemia in addition to inducing MAS in healthy individuals 1–3 …”

“…In the literature, brucellosis can present in different ways and hyperferritinemia is one of its features, especially when associated with sHLH (Table 1). 1–4,5 Clinicians should bear in mind this rare phenomenon, in some parts of the world, in the differential diagnosis of hyperferritinemia.…”