Pancytopenia in Children with Brucellosis: Clinical Manifestations and Bone Marrow Findings

Abstract

Among 276 paediatric cases of brucellosis seen over a 7-year period, 16 patients (5.8%) with pancytopenia were identified. The most frequent presentations were fever, malaise, anorexia, weight loss, arthralgia, and hepatosplenomegaly. Fourteen patients (87.5%) had positive blood and/or bone marrow cultures for Brucella melitensis. Bone marrow aspiration specimens showed hypercellular-ity in 14 patients and normocellularity in 2. Histiocytes, eosinophils and plasma cells were increased in every marrow aspirate, and haemophagocytosis was observed in 14 patients (87.5%). Non-caseating granulomas were present in the bone marrow biopsy of 11 patients (68.8%). The pancytopenia was transient, and resolved on treatment of the Brucella infection.

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

“…The presence of bone marrow granulomas has been demonstrated in brucellosis [17,25,26]. The Brucella-associated granulomas tend to be small and poorly defined, and caseation necrosis never occurs, as demonstrated in our study.…”

“…Several data have been reported on the frequency and diversity of hematological abnormalities occurring in brucellosis [6,7,17]. In the published series, the incidence of pancytopenia with brucellosis varies from 3 to 21% [5,17,18]. In this study, 202 patients with brucellosis were investigated and pancytopenia was detected in 30 (14.9%).…”

“…We have previously reported inter- esting cases of brucellosis in patients presenting with either initial hematological manifestations or unexplained fever that were referred to our university hospitals' hematologyoncology clinics [11][12][13][14][15][16]. Several data have been reported on the frequency and diversity of hematological abnormalities occurring in brucellosis [6,7,17]. In the published series, the incidence of pancytopenia with brucellosis varies from 3 to 21% [5,17,18].…”

“…The pathogenesis of pancytopenia in brucellosis has not been clearly understood, but it seems to be multifactorial. Several possible mechanisms have been suggested for pancytopenia caused by brucellosis, such as hemophagocytosis, hypersplenism, bone marrow granulomas, bone marrow hypoplasia, and immune destruction [17][18][19][20][21].…”

Brucellosis presenting with pancytopenia due to hemophagocytic syndrome

“…A search of the literature showed that there are only 3 published reports of hemophagocytosis secondary to brucellosis in children [11][12][13]. Hemophagocytic syndrome in children should be differentiated from familial HLH, which is characterized by early onset, a higher prevalence of parental consanguinity, and an association with immune deficiencies, such as ChediakHigashi syndrome, Griscelli syndrome, and X-linked lymphoproliferative syndrome.…”