Concurrent Brucellosis and Acute Lymphoblastic Leukemia: A Case Report

Area of Science:

• Hematology
• Infectious Diseases
• Oncology

Background:

• Acute lymphoblastic leukemia (ALL) impairs immunity, increasing infection risk.
• Brucellosis shares nonspecific symptoms with leukemia, complicating diagnosis.
• Co-occurrence of ALL and brucellosis is rare but clinically significant.

Purpose of the Study:

• To report a rare case of concurrent B-cell ALL and brucellosis.
• To emphasize the diagnostic challenges posed by overlapping symptoms.
• To highlight the importance of considering brucellosis in febrile leukemia patients.

Main Methods:

• Case report of a 47-year-old male shepherd from Iran.
• Initial diagnosis of B-cell ALL confirmed by bone marrow aspiration and flow cytometry.
• Management involved chemotherapy (hyper-CVAD, dasatinib) and antibiotics (rifampin, doxycycline) after brucellosis re-diagnosis.

Main Results:

• Patient initially presented with ALL symptoms and negative brucellosis tests.
• Persistent fever led to re-evaluation and positive brucellosis serology, suggesting a prozone effect.
• Integrated treatment resulted in rapid clinical improvement and complete remission of ALL, maintained for 2 years.

Conclusions:

• Brucellosis should be considered in the differential diagnosis of febrile hematologic malignancy patients in endemic areas.
• Overlapping clinical presentations can cause diagnostic delays.
• Repeat serological testing or serial dilutions are crucial for diagnosing brucellosis in immunocompromised patients with persistent suspicion.