Wu Liankui, Zhang Guoqing, Dang Sheng, Zhang Shuai, Zhao Leheng, Zhai Jingbo
Department of Intensive Medicine, Affiliated Hospital of Inner Mongolia Minzu University, Tongliao, 028000, China.
Innovative Institute of Zoonoses, Inner Mongolia Minzu University, Tongliao, 028000, China.
Heliyon. 2023 Aug 5;9(8):e18907. doi: 10.1016/j.heliyon.2023.e18907. eCollection 2023 Aug.
Brucellosis is a common zoonotic infectious disease with diverse and non-specific clinical manifestations caused by Although can cause damage to multiple systems in the human body, hematological complications are relatively rare. We present a case of a 47-year-old male brucellosis patient with pancytopenia. In May 2018, the patient was diagnosed with brucellosis and recovered after receiving antibiotic treatment (rifampicin 600 mg/day and doxycycline 200 mg/day) for six weeks. However, after three years, the patient experienced a recurring high fever. Brucellosis relapse was confirmed based on the patient's clinical history, Rose Bengal plate agglutination test and standard tube agglutination test results. Routine blood examination revealed a decrease in the whole blood cell count, suggesting bone marrow suppression. Bone marrow aspiration and bacterial culture confirmed the diagnosis of brucellosis with pancytopenia. Antibiotic treatment failed to effectively improve the patient's condition. Therefore, a combination of immunomodulatory and antibiotic treatments was used. The antibiotic regimen included oral rifampicin 600 mg/day, intravenous doxycycline hydrochloride 200 mg/day, and subcutaneous injection of human granulocyte-stimulating factor (0.2 mg/day). Immunomodulatory therapy consisted of 20,000 mg/day intravenous human immunoglobulin (pH 4) for five days and 800 mg/day oral pidotimod liquid for 20 days. As the treatment progressed, the count gradually recovered to normal levels, and the symptoms of bone marrow suppression were alleviated. PCR testing revealed the absence of DNA in both monocyte and serum samples. Furthermore, negative standard tube agglutination test results were obtained. These findings indicate that the immunomodulatory therapy resulted in a complete clearance of Therefore, immunomodulatory therapy could be an effective option in cases of brucellosis with pancytopenia that are unresponsive to conventional antibiotic treatment. Further research and clinical evidence are required to confirm and optimize the use of immunomodulatory therapies in patients with brucellosis.
布鲁氏菌病是一种常见的人畜共患传染病，由[病原体名称未给出]引起，临床表现多样且不具特异性。尽管[病原体名称未给出]可对人体多个系统造成损害，但血液学并发症相对少见。我们报告一例47岁男性布鲁氏菌病患者出现全血细胞减少的病例。2018年5月，该患者被诊断为布鲁氏菌病，接受抗生素治疗（利福平600毫克/天和多西环素200毫克/天）六周后康复。然而，三年后，患者再次出现高热。根据患者的临床病史、玫瑰红平板凝集试验和标准试管凝集试验结果，确诊为布鲁氏菌病复发。血常规检查显示全血细胞计数减少，提示骨髓抑制。骨髓穿刺及细菌培养确诊为布鲁氏菌病伴全血细胞减少。抗生素治疗未能有效改善患者病情。因此，采用了免疫调节治疗与抗生素治疗相结合的方法。抗生素治疗方案包括口服利福平600毫克/天、静脉注射盐酸多西环素200毫克/天以及皮下注射人粒细胞刺激因子（0.2毫克/天）。免疫调节治疗包括静脉注射人免疫球蛋白（pH 4）20000毫克/天，共五天，以及口服匹多莫德口服液800毫克/天，共20天。随着治疗进展，血细胞计数逐渐恢复至正常水平，骨髓抑制症状得到缓解。PCR检测显示单核细胞和血清样本中均未检测到[病原体名称未给出]DNA。此外，标准试管凝集试验结果为阴性。这些结果表明免疫调节治疗导致[病原体名称未给出]被完全清除。因此，对于常规抗生素治疗无效的布鲁氏菌病伴全血细胞减少病例，免疫调节治疗可能是一种有效的选择。需要进一步的研究和临床证据来证实并优化免疫调节治疗在布鲁氏菌病患者中的应用。
