title: 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.
abstract: The aim of the study is to review the clinical manifestations and the hematological findings of brucellosis and pancytopenia, with or without hematological malignancies. The records of 202 patients with brucellosis were evaluated retrospectively. Among these cases of brucellosis seen in a 6 year period between April 1999 and June 2005, 30 patients with pancytopenia were identified. The most common manifestation was fever, followed by weight loss, anorexia, malaise, arthralgia, and hepatosplenomegaly. Bone marrow biopsies revealed hypercellularity or normocellularity. The most common findings in the bone marrow evaluation were histiocytic hemophagocytosis and granulomas. Among all cases, we diagnosed 5 hematological malignancies (1 acute myelogenous leukemia, 2 acute lymphoblastic leukemia, and 2 multiple myeloma) concurrently with brucellosis. The clinical symptoms and findings were similar in patients with and without malignancies. In cases with malignancies, the bone marrow biopsy revealed predominant primary disease involvement. Significant increases in ESR and CRP, severe anemia and thrombocytopenia were observed in patients with malignancies. Peripheral blood counts in patients without malignancies returned to normal after antibiotic treatment for brucellosis. However, pancytopenia in two patients with malignancies did not recover because of primary resistant disease. We conclude that while histiocytic hemophagocytosis may be considered as a major cause of pancytopenia, leukemic infiltration can also be an extreme and unusual cause of pancytopenia in patients in whom brucellosis was concurrently diagnosed with hematological malignancies.
authors: Department of Hematology, Faculty of Medicine, Pamukkale University, Denizli, Turkey. hisari@pau.edu.tr
authors: Ismail
authors: I
authors: Sari
authors: Fevzi
authors: F
authors: Altuntas
authors: Sibel
authors: S
authors: Hacioglu
authors: Ismail
authors: I
authors: Kocyigit
authors: Alper
authors: A
authors: Sevinc
authors: Suzan
authors: S
authors: Sacar
authors: Kemal
authors: K
authors: Deniz
authors: Emine
authors: E
authors: Alp
authors: Bulent
authors: B
authors: Eser
authors: Orhan
authors: O
authors: Yildiz
authors: Leylagul
authors: L
authors: Kaynar
authors: Ali
authors: A
authors: Unal
authors: Mustafa
authors: M
authors: Cetin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000372:Agglutination Tests; D001853:Bone Marrow / Q000473:pathology; D002006:Brucellosis / Q000097:blood / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology; D015897:Comorbidity; D005260:Female; D019337:Hematologic Neoplasms / Q000097:blood / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology; D006801:Humans; D015479:Leukemia, Myelomonocytic, Acute / Q000097:blood / Q000150:complications / Q000473:pathology; D017254:Leukemic Infiltration; D051359:Lymphohistiocytosis, Hemophagocytic / Q000150:complications / Q000453:epidemiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000097:blood / Q000150:complications / Q000473:pathology; D010198:Pancytopenia / Q000097:blood / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000097:blood / Q000150:complications / Q000473:pathology; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome