[A case of brucellosis misdiagnosed as Crimean-Congo hemorrhagic fever]

Brucellosis which is a zoonotic infection, is an important public health problem in Turkey and all over the world. The disease may involve many organs and systems. Since the symptoms of brucellosis are non-specific, difficulties in differential diagnosis and misdiagnosis are frequent. In this case report we present a case of brucellosis, misdiagnosed as Crimean-Congo hemorrhagic fever (CCHF). A 13-year-old boy was referred from another medical center with preliminary diagnosis of CCHF and admitted to our clinic with fever and a history of presence of a tick on his back. His physical observation only included splenomegaly. The laboratory results on admission were anemia, thrombocytopenia, elevation of acute phase reactants and liver transaminase levels. Abdominal ultrasonography revealed splenomegaly. Since the patient had anemia, epistaxis, fever and thrombocytopenia, he was initially diagnosed as CCHF. Meantime serum sample of the patient had been sent to Refik Saydam National Public Health Agency for CCHF PCR test. The fever of the patient could not be controlled. His detailed medical history revealed stockbreeding and consumption of raw milk products. Patient's signs and symptoms were also compatible with brucellosis and standard tube agglutination test for brucellosis was positive at 1/1280 titer in serum. The patient was diagnosed as brucellosis and the treatment was started with combination of rifampicin (1 x 600 mg/day) and doxycycline (2 x 100 mg/day). Blood cultures yielded negative result. The PCR tests for CCHF was found also negative. His fever and other complaints improved with treatment which was completed in six weeks and the follow-up was without complications. Turkey is endemic both for brucellosis and CCHF. This case was reported to emphasize that the cases of brucellosis could mimic other diseases and brucellosis should also be considered in the differential diagnosis of CCHF.