Autoimmune Hemolytic Anemia - Rare Complication of Brucellosis in a Saudi Woman: A Case Report and Literature Review.

BACKGROUND Autoimmune hemolytic anemia and immune thrombocytopenia are rare complications of brucellosis; only a few cases have been reported in the literature. While pancytopenia is common and was reported in Saudi Arabia, the description of autoimmune hemolytic anemia or immune thrombocytopenia has not yet been reported in the kingdom. Hematological complication usually requires supportive treatment, and it is expected to improve with the initiation of antimicrobial therapy for brucellosis. There are few reports on the treatment of patients that fail to improve with conventional therapy. CASE REPORT A 46-year-old previously healthy Saudi woman was admitted to our hospital after multiple visits to the emergency department with chief concerns of fever and fatigability for 30 days. The examination was remarkable only for fever of 38.4°C and tender hepatomegaly. Laboratory tests upon admission were significant of pancytopenia, with a white blood count of 3×10⁹/L, hemoglobin of 8.1 g/dL, platelet of 13×10⁹/L, moderate hyponatremia, hypokalemia, and metabolic acidosis. Tuberculosis was ruled out and pan-sensitive brucellosis was diagnosed. She was started on standard antimicrobial therapy without significant improvement. Further testing revealed Coomb's-positive hemolytic anemia and possible immune-mediated severe thrombocytopenia. She was treated with glucocorticoids and intravenous immunoglobulin, with dramatic response. CONCLUSIONS Autoimmune-mediated destruction of blood lines in brucellosis is rare. It should be sought as a potential diagnosis in case of persistent anemia and/or thrombocytopenia that is severe or fails to improve with proper antimicrobial coverage. Early involvement of hematologists and initiation of glucocorticoid with or without intravenous immunoglobulin is crucial.