KOLESTAZ KLİNİĞİ İLE BAŞVURAN AKUT BRUCELLA HEPATİTİ OLGUSU

Öz

Bruselloz; enfekte hayvanın sıvılarının direk insana teması veya enfekte hayvandan elde edilmiş pastörize edilmeyen süt ve peynirden insana bulaşan zoonotik bir enfeksiyondur. Bruselloz da gastrointestinal tutulum vakaların yüzde 3-6’sında klinik hepatit şeklinde seyreder ve akut hepatit nadir karşılaşılan bir durumdur. 62 yaşında bayan hasta halsizlik, ateş ve skleralarda sararma şikayetleri ile kliniğimize başvurdu. Hasta akut kolanjit ön tanısı ile kliniğe yatırıldı. Hastaneye ilk başvuru laboratuvar değerleri lökosit: 9.35 10⁹/L, hemoglobin: 11,5 g/dL, platelet: 139 10⁹/L, uluslararası normalleştirilmiş oran 0.95, sedimantasyon 35 mm, C-reaktif protein: 9 mg/dL, albumin 2.5 g/dL, total bilirubin/direkt bilirubin 7.4/5.8 mg/dL, aspartat aminotransferaz: 784 U/L, alanin aminotransferaz: 418 U/L, alkalen fostafataz: 363 U/L, gama glutamil transpeptidaz: 210 U/L, laktat dehidrogenaz: 737 U/L idi. Yapılan batın ultrasonografide karaciğer, intrahepatik safra yolları ve koledok normal izlendi. Hastanın klinik takiplerinde ondülan ateş paterni mevcuttu. Çalışılan Brusella Rose Bengal Lam Aglütinasyon testi pozitif bulundu ve Brusella Coombs Aglütinasyon testi 1/1280 titrede pozitif saptandı. Hastanın kan kültürlerinde de Brucella üremesi oldu. Hastaya oral doksisiklin 100 mg 2 × 1 ve rifampisin 300 mg 1 × 2 tedavisi altı hafta verildi. Hastanın takiplerde klinik ve laboratuvar tablosu düzeldi. Özellikle ateşin eşlik ettiği akut hepatit ve kolestaz hastalarında ayırıcı tanıda Brusellozisin düşünülmesi önerilir.

Anahtar Kelimeler

• Bruselloz,akut hepatit,akut kolanjit

A CASE OF ACUTE BRUCELLA HEPATITIS PRESENTING WITH CHOLESTASE CLINIC

Öz

Brucellosis is a zoonotic infection that is transmitted to humans through the direct contact of fluids of the infected animal or through the consumption of nonpasteurized milk or cheese obtained from the infected animal. In brucellosis, gastrointestinal involvement occurs as clinical hepatitis in 3%[Author1] –6% of cases, and acute hepatitis is a rare condition. A 62-year-old female patient presented to our clinic with complaints of weakness, fever, and yellowing of the sclera. The patient was hospitalized with a preliminary diagnosis of acute cholangitis. At the first admission, the laboratory parameters were white blood cells 9.35 × 10⁹/L, hemoglobin: 11.5 g/dL, platelets: 139 × 10⁹/L, international normalized ratio: 0.95, sedimentation 35 mm, C-reactive protein: 9 mg/dL, albumin 2.5 g/dL, total bilirubin/direct bilirubin 7.4/5.8 mg/dL, aspartate aminotransferase 784 U/L, alanine aminotransferase 418 U/L, alkaline phosphatase 363 U/L, gamma-glutamyl transferase 210 U/L, and lactate dehydrogenase 737 U/L. Abdominal ultrasonography revealed normal findings in the liver, intrahepatic bile ducts, and choledochus. During the clinical follow-up, the patient had insidious fever patterns. Brucella Rose Bengal Lam Agglutination test showed a positive result, and Brucella Coombs Agglutination test also demonstrated a positive result at 1:1280 titer. In addition, brucella was detected in the blood cultures of the patient. Oral doxycycline 100 mg 2 × 1 [Author2] and rifampicin 300 mg 1 × 2 were administered for 6 weeks, after which the patient showed improvement in the clinical and laboratory findings. Therefore, it is recommended to consider brucellosis in the differential diagnosis, especially in patients with fever having acute hepatitis and cholestasis.

Anahtar Kelimeler

• Brucellosis,acute hepatitis,acute cholangitis

Kaynakça

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