A case of disseminated intravascular coagulation caused by Brucella melitensis.
OBJECTIVE
Although the haematological abnormalities were common accompaniments of brucellosis, overt disseminated intravascular coagulopathy was reported only in a case at the literature. We report here a case of Brucella melitensis sepsis which showed an acute onset with clinical and hematological findings disseminated intravascular coagulopathy


METHODS
The patient had a physical examination, coagulation screening tests, tests of thrombin generation and fibrinolysis, bone marrow aspirate, serum Brucella agglutination test and blood culture. A case of Brucella infection presenting at the onset as a disseminated intravascular coagulation with gingival bleeding and echimotic lesions on abdomen is reported. A hemogram showed severe thrombocytopenia, anemia, and leukopenia. Anisocytozis, poikilocytozis, shift to the left of the granulocytic series, fragmented red blood cells, toksic granulation, were present in the peripheral smear. Bone marrow aspirate revealed a hypercellular marrow without granulomata or malignant precursors. Prothrombin time: 20 s, activated partial thromboplastin time:53.9 s were found longer than normal. D-dimer: 1056 mug/l (50-228 mug/l) was found. Fibrinogen was too low to detected in serum. Patient had Brucella melitensis isolated from blood cultures.


RESULTS
After appropriate antimicrobial therapy, the clinical and hematological status of the patient improved, and 4 days later with disappearance of all hematological abnormalities. CONCLUSISON: Diagnosis of brucellosis may be delayed, particularly if uncommon features such as pancytopenia and disseminated intravascular coagulopathy are present. Hence, brucellosis must be considered in the differential diagnosis of all those conditions leading to pancytopenia and disseminated intravascular coagulopathy in areas endemic for brucellosis.
Turunc
Tuba
T
Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Başkent University, Ankara 06490, Turkey. tubaturunc@yahoo.com
Demiroglu
Yusuf Ziya
YZ
Kizilkilic
Ebru
E
Aliskan
Hikmet
H
Boga
Can
C
Arslan
Hande
H
D000372:Agglutination Tests; D000890:Anti-Infective Agents / Q000627:therapeutic use; D001777:Blood Coagulation; D001780:Blood Coagulation Tests; D001856:Bone Marrow Examination; D017347:Brucella melitensis / Q000302:isolation & purification*; D002006:Brucellosis / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D004211:Disseminated Intravascular Coagulation / Q000097:blood / Q000382:microbiology* / Q000473:pathology / Q000628:therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D010198:Pancytopenia / Q000382:microbiology; D017713:Platelet Transfusion; D016896:Treatment Outcome
D000890:Anti-Infective Agents