Polat K Y, Tosun M S, Ertekin V, Aydinli B, Emre S
Department of Transplant Surgery, Memorial Atasehir Hospital, Istanbul, Turkey.
Transpl Infect Dis. 2012 Jun;14(3):326-9. doi: 10.1111/j.1399-3062.2011.00709.x. Epub 2012 Jan 20.
Brucellosis is considered the most widespread zoonosis in the world. It has been reported that the prevalence of seropositivity among the Turkish population varies from 3% to 14%. We present a case of brucellosis after pediatric liver transplantation. A 15-year-old boy with the diagnosis of neuro Wilson's disease underwent deceased-donor liver transplantation. The postoperative immunosuppressive protocol consisted of steroids and tacrolimus. Two months after the operation the patient experienced fever to 40°C. The patient complained of poor appetite, headache, and diarrhea. He had had pancytopenia. Despite administration of appropriate antibiotics, antiviral and antifungal agents, fever persisted for > 1 month. Multiple blood, urine, stool, and sputum cultures were negative. Bone marrow aspirate revealed hypocellularity. Liver biopsy was performed, but rejection was not observed on biopsy specimen. Brucella serology was positive and Brucella agglutination titer was 1:320. Bone marrow culture was positive for Brucella but blood culture was negative. The patient was then treated with oral doxycycline and rifampin for 8 weeks. No previous case report about Brucella infection after liver transplantation has appeared in the literature, to our knowledge; our case is presented as the first. Bone marrow hypoplasia is a rare feature of Brucella infection. Our patient with brucellosis and pancytopenia had had hypocellular bone marrow. The clinical and hematologic findings resolved with treatment of the infection. Brucella infection should be suspected in liver transplanted recipients with fever of unknown origin, especially in a recipient who has lived in an endemic area. Brucella also should be considered as a possible diagnosis in patients with pancytopenia.
布鲁氏菌病被认为是世界上分布最广泛的人畜共患病。据报道，土耳其人群中血清阳性率在3%至14%之间。我们报告一例小儿肝移植后发生布鲁氏菌病的病例。一名诊断为神经型威尔逊病的15岁男孩接受了尸体供肝肝移植。术后免疫抑制方案包括类固醇和他克莫司。术后两个月，患者体温升至40°C。患者主诉食欲减退、头痛和腹泻。他曾出现全血细胞减少。尽管使用了适当的抗生素、抗病毒和抗真菌药物，发热仍持续超过1个月。多次血液、尿液、粪便和痰液培养均为阴性。骨髓穿刺显示细胞减少。进行了肝活检，但活检标本未观察到排斥反应。布鲁氏菌血清学检查呈阳性，布鲁氏菌凝集效价为1:320。骨髓培养布鲁氏菌阳性，但血培养阴性。然后该患者接受口服强力霉素和利福平治疗8周。据我们所知，此前文献中未出现过肝移植后布鲁氏菌感染的病例报告；我们的病例是首例报道。骨髓发育不全是布鲁氏菌感染的罕见特征。我们这位患有布鲁氏菌病和全血细胞减少的患者出现了细胞减少的骨髓。感染经治疗后，临床和血液学表现得到缓解。对于不明原因发热的肝移植受者，尤其是居住在流行地区的受者，应怀疑布鲁氏菌感染。对于全血细胞减少的患者，也应考虑布鲁氏菌感染作为可能的诊断。
