KOLESTAZ KLİNİĞİ İLE BAŞVURAN AKUT BRUCELLA HEPATİTİ OLGUSU

Yıl 2019, Cilt: 18 Sayı: 2, 76 - 78, 15.09.2019

Ali Rıza Çalışkan Hasan Esat Yıldırım Funda Yetkin Oğuzhan Yıldırım

https://doi.org/10.17941/agd.621519

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

• 1. Bosilkovski M, Dimzova M, Grozdanovski K, et al. Natural history of brucellosis in an endemic region in different time periods. Acta Clin Croat 2009;48:41-6.
• 2. Colmenero JD, Reguera JM, Martos F, et al. Complications associated with Brucella melitensis infection: a study of 530 cases. Medicine (Baltimore) 1996;75:195-211.
• 3. Guerrant RL, Walker DH, Weller PF. Tropical infectious diseases: principles, pathogens and practice. Saunders/Elsevier. 2011.
• 4. Pappas G, Panagopoulou P, Christou L, Akritidis N. Brucella as a biological weapon. Cellular and molecular life sciences. Cell Mol Life Sci 2006;63:2229-36.
• 5. Pappas G, Papadimitriou P, Akritidis N, Christou L, Tsianos EV. The new global map of human brucellosis. Lancet Infect Dis 2006;6:91-9.
• 6. Bosilkovski M, Krteva L, Caparoska S, Dimzova M. Osteoarticular involvement in brucellosis: study of 196 cases in the Republic of Macedonia. Croat Med J 2004;45:727-33.
• 7. Albayrak A, Albayrak F. Hepatic granulomas associated with brucellosis: Hepatic granulomas and brucellosis. Hepat Mon 2011;11:1-2.
• 8. Ozturk-Engin D, Erdem H, Gencer S, et al. Liver involvement in patients with brucellosis: results of the Marmara study. Eur J Clin Microbiol Infect Dis 2014;33: 1253- 62.
• 9. Sahinturk H, Baran B, Sisman G, Altun R. Liver involvement is associated with blood culture positivity and high agglutination titre in patients with brucellosis in Turkey. J Med Microbiol 2018;67:1078-82.
• 10. Uluğ M, Celen MK, Ayaz C. An unusual presentation of brucellosis: acute hepatitis. Braz J Infect Dis 2010;14:641-2.
• 11. Fernandez-Rodriguez AM, Guindeo-Casasus MC, Molero-Labarta T, et al. Diagnosis of iron deficiency in chronic renal failure. Am J Kidney Dis 1999;34:508-13.
• 12. Buzgan T, Karahocagil MK, Irmak H, et al. Clinical manifestations and complications in 1028 cases of brucellosis: a retrospective evaluation and review of the literature. Int J Infect Dis 2010;14:e469-78.
• 13. Dornand J, Gross A, Lafont V, et al. The innate immune response against Brucella in humans. Vet Microbiol 2002;90:383-94.
• 14. Skalsky K, Yahav D, Bishara J, et al. Treatment of human brucellosis: systematic review and meta-analysis of randomised controlled trials. BMJ 2008;336:701-4.
• 15. Solera J, Martínez-Alfaro E, Sáez L. Meta-analysis of the efficacy of the combination of +rifampicin and doxycycline in the treatment of human brucellosis. Med Clin (Brc) 1994;102:731-8.