A rare pediatric case of immune thrombocytopenia attributed to brucellosis

Brucellosis is a zoonotic infection transmitted to humans by ingestion of contaminated unpasteurized dairy products or via direct or indirect contact with infected animals. It is characterized by nonspecific symptoms like fever and joint pain, and laboratory findings including anemia, leukopenia, thrombocytopenia, or rarely pancytopenia. Here we report a case of brucellosis with thrombocytopenia that did not improve despite anti-brucella treatment and required intravenous immunoglobulin treatment.

A six-year-old boy from a brucellosis-endemic area presented with fever and fatigue. Initial laboratory tests showed moderate thrombocytopenia and a Brucella agglutination titer of 1/320. Brucella spp. was isolated from blood culture. Rifampicin, trimethoprim-sulfamethoxazole (TMP-SMX), and gentamicin treatment were given to the patient, and clinical improvement followed, with normalization of blood count. However, on day 10, severe thrombocytopenia with epistaxis and ecchymosis developed, suggestive of immune thrombocytopenia (ITP). Intravenous immunoglobulin at a dose of 1000 mg/kg was given, resulting in a rise in platelet count. The patient was discharged with rifampicin and TMP-SMX. During follow-up, his platelet levels returned to normal without the need for additional immunoglobulin, suggesting resolution of Brucella-related immune thrombocytopenia.

Brucellosis should be kept in mind in the differential diagnosis of thrombocytopenia in endemic regions. If there is no response to antimicrobial treatment in brucellosis patients presenting with thrombocytopenia, immune thrombocytopenia should be considered.