Febrile neutropenia in an immunocompetent patient with brucellosis: a case report and literature review.

Fasih Mand Khan, Ariba Khan, Sandesh Raja, Adarsh Raja, Asfia Qammar, Aayush Chaulagain
Author Information
  1. Fasih Mand Khan: Fatima Memorial College of Medicine and Dentistry, Lahore, Pakistan.
  2. Ariba Khan: Services Institute of Medical Sciences, Lahore, Pakistan.
  3. Sandesh Raja: Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
  4. Adarsh Raja: Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan.
  5. Asfia Qammar: Baylor Scott & White Heart and Vascular Hospital, Dallas.
  6. Aayush Chaulagain: Department of Medicine, Patan Academy of Health Sciences, Patan, Nepal.

Abstract

Introduction and importance: Brucellosis is a zoonotic disease that can affect various organs, with symptoms like fever, lymphadenopathy, and arthritis. Hematologic complications, including febrile neutropenia, are rare. This report highlights the diagnostic and therapeutic challenges of brucellosis with febrile neutropenia.
Case presentation: A 36-year-old man presented with a 3-week history of fever, polyarthralgia, and night sweats. Examination showed febrile symptoms, joint swelling, and cervical lymphadenopathy. Laboratory tests revealed neutropenia and elevated inflammatory markers. Imaging was unremarkable, and blood cultures were negative, but brucellosis was confirmed by serology. Treatment with doxycycline and rifampicin led to clinical improvement.
Clinical discussion: Brucellosis diagnosis can be challenging due to nonspecific symptoms and requires high suspicion, especially in non-endemic areas. In this case, early identification and targeted therapy led to symptom resolution. This case underlines the importance of considering zoonotic diseases in febrile neutropenia with inconclusive initial findings.
Conclusion: Brucellosis with febrile neutropenia is rare but manageable with timely diagnosis and treatment, leading to favorable outcomes.

Keywords

References

  1. Clin Lab Sci. 1999 Jul-Aug;12(4):207-12 [PMID: 10558306]
  2. J Antimicrob Chemother. 1986 Apr;17(4):459-61 [PMID: 2940209]
  3. J Chemother. 2002 Feb;14(1):88-91 [PMID: 11892906]
  4. Heliyon. 2024 Mar 15;10(6):e28041 [PMID: 38545216]
  5. Front Vet Sci. 2022 Dec 22;9:976215 [PMID: 36619963]
  6. BMJ. 2008 Mar 29;336(7646):701-4 [PMID: 18321957]
  7. Acta Med Okayama. 1998 Feb;52(1):63-5 [PMID: 9548996]
  8. Int J Surg. 2023 May 01;109(5):1136-1140 [PMID: 37013953]
  9. Eur J Clin Microbiol Infect Dis. 2012 Apr;31(4):441-3 [PMID: 21725863]
  10. Expert Rev Anti Infect Ther. 2008 Feb;6(1):109-20 [PMID: 18251668]
  11. Med Oncol. 2011 Mar;28(1):255-7 [PMID: 20169426]
  12. Antibiot Khimioter. 1993 Dec;38(12):18-20 [PMID: 8085903]
  13. Medicine (Baltimore). 1996 Jul;75(4):195-211 [PMID: 8699960]
  14. Pediatr Infect Dis J. 2022 Oct 1;41(10):e430-e433 [PMID: 35830519]
  15. Pediatr Hematol Oncol. 2011 Feb;28(1):83-5 [PMID: 20863159]
  16. Indian J Pediatr. 2016 Sep;83(9):1022-3 [PMID: 27173647]
  17. PLoS Negl Trop Dis. 2020 May 21;14(5):e0008071 [PMID: 32437346]
  18. N Engl J Med. 2005 Jun 2;352(22):2325-36 [PMID: 15930423]
  19. J Med Case Rep. 2007 Nov 23;1:144 [PMID: 18036218]
  20. Int J Clin Pract. 2007 Jul;61(7):1237-8 [PMID: 17343671]
  21. Leuk Lymphoma. 2006 May;47(5):954-6 [PMID: 16753892]
  22. Mikrobiyol Bul. 2014 Oct;48(4):669-73 [PMID: 25492662]
  23. Vector Borne Zoonotic Dis. 2015 Mar;15(3):195-201 [PMID: 25793475]
  24. Emerg Infect Dis. 2023 Sep;29(9):1789-1797 [PMID: 37610167]
  25. PLoS One. 2017 Jan 20;12(1):e0170376 [PMID: 28107444]
  26. Indian J Med Microbiol. 2007 Jul;25(3):188-202 [PMID: 17901634]
  27. Med Pediatr Oncol. 2000 Nov;35(5):496-7 [PMID: 11070484]
  28. J Lab Physicians. 2014 Jan;6(1):14-7 [PMID: 24696554]
  29. Acta Haematol. 1993;89(3):132-6 [PMID: 8362601]
  30. Transbound Emerg Dis. 2019 Nov;66(6):2383-2401 [PMID: 31309735]
  31. Clin Exp Vaccine Res. 2021 Jan;10(1):35-43 [PMID: 33628752]
  32. Trop Med Infect Dis. 2018 Jun 14;3(2): [PMID: 30274461]

Word Cloud

Created with Highcharts 10.0.0neutropeniafebrilecaseBrucellosiszoonoticsymptomsreportbrucellosisdiseasecanfeverlymphadenopathyrareserologyleddiagnosisIntroductionimportance:affectvariousorganslikearthritisHematologiccomplicationsincludinghighlightsdiagnostictherapeuticchallengesCasepresentation:36-year-oldmanpresented3-weekhistorypolyarthralgianightsweatsExaminationshowedjointswellingcervicalLaboratorytestsrevealedelevatedinflammatorymarkersImagingunremarkablebloodculturesnegativeconfirmedTreatmentdoxycyclinerifampicinclinicalimprovementClinicaldiscussion:challengingduenonspecificrequireshighsuspicionespeciallynon-endemicareasearlyidentificationtargetedtherapysymptomresolutionunderlinesimportanceconsideringdiseasesinconclusiveinitialfindingsConclusion:manageabletimelytreatmentleadingfavorableoutcomesFebrileimmunocompetentpatientbrucellosis:literaturereview

Similar Articles

Cited By