Kitt Eimear, Brannock Kristina R, VonHolz Lauren A, Planet Paul J, Graf Erin, Pillai Vinodh
Division of Infectious Diseases and.
Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Pennsylvania.
Open Forum Infect Dis. 2017 Feb 10;4(1):ofw263. doi: 10.1093/ofid/ofw263. eCollection 2017 Winter.
An 8-year old girl presented to our facility with a 10-day history of fever, fatigue, abdominal pain and refusal to walk. She recently travelled from her native Algeria where she first developed symptoms. On evaluation, she was ill-appearing, febrile and tachycardic with hepatosplenomegaly and lymphadenopathy noted on examination. A strong musty odor was also noted from the child. Laboratory evaluation revealed pancytopenia, hyponatremia, and an elevated AST, ALT, and LDH. Malaria testing was negative, as was a PPD. On further questioning, the family reported multiple sick contacts in Algeria with similar symptoms. After discussion with Oncology and Infectious Diseases, she underwent a bone marrow biopsy that was significant for multiple non-caseating ring granulomas. She was started on combination therapy of doxycycline and for presumed brucellosis infection with improvement in her symptoms and resolution of fever. Bone marrow culture returned several days later positive for Brucella melitensis.
一名8岁女孩因发热、疲劳、腹痛和拒绝行走10天前来我院就诊。她最近从家乡阿尔及利亚旅行归来，在那里她首次出现症状。经评估，她看起来病恹恹的，发热且心动过速，检查发现有肝脾肿大和淋巴结病。还注意到孩子身上有强烈的霉味。实验室检查显示全血细胞减少、低钠血症，以及天门冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）和乳酸脱氢酶（LDH）升高。疟疾检测呈阴性，结核菌素试验（PPD）也呈阴性。进一步询问后，家人报告说在阿尔及利亚有多名有类似症状的患病接触者。在与肿瘤科和传染病科讨论后，她接受了骨髓活检，结果显示有多个非干酪样环状肉芽肿。考虑到可能感染布鲁氏菌病，她开始接受强力霉素联合治疗，症状有所改善，发热消退。几天后骨髓培养结果显示马尔他布鲁氏菌呈阳性。
