Acute thrombocytopenia with bleeding as the initial manifestation of brucellosis

Abstract

Severe thrombocytopenia with bleeding is rarely reported in children with brucellosis. Brucellosis with hemorrhage should be differentiated from viral hemorrhagic fever, malignancy and other blood disorders. Bone marrow aspiration (BMA) is mandatory to differentiate from other blood diseases. An 8-year-old boy was admitted with petechiae and purpura on face and extremities, bleeding from the gums and recurrent epistaxis. During the hospitalization, he was febrile and complained of muscle pain. Leukopenia associated with thrombocytopenia were observed. BMA showed to be normal. Among the multiple tests requested, only serum agglutination test (SAT) and 2-MercaptoEthanol test (2-ME) were positive. He was treated with Intravenous immunoglobulin (IVIG) associated with co-trimoxazole and rifampin. Finally, fever subsided and he was discharged with good condition and normal platelet count. Brucellosis should be a differential diagnosis in patients with fever and bleeding disorders and a history of consumption of unpasteurized dairy, in endemic areas.

Keywords

• Brucellosis
• Epistaxis
• Purpura
• Severe Thrombocytopenia