A rare presentation of brucellosis: acute cholestatic hepatitis

Abstract

Abstract: Introduction: Brucellosis can present with clinical hepatitis and rarely as acute cholestatic hepatitis. The aim of the study is to demonstrate acute cholestatic hepatitis as a rare presentation caused by Brucella melitensis. Case Presentation: A thirty-nine-years-old male patient was admitted to our department with the complaints of fever, malaise, fatigue and sweating. At hospitalization, the temperature was 39°C. Laboratory tests: White blood count (WBC) 4800 cells/mm3, platelet (PLT) 173 000/mm3, erythrocyte sedimentation rate (ESR) 38mm/h, C-reactive protein (CRP) 257 mg/L, alanine transferase (ALT) 284 U/L, aspartate transferase (AST) 300U/L, γ-glutamyl transpeptidase (GGT) 1152U/L, alkaline phosphatase (ALP) 1762U/L, total bilirubin (T-Bil) 2.8mg/dL, direct bilirubin (D-Bil) 1.3mg/dL, lactate dehydrogenase (LDH) 705 U/L. Gruber Widal test was negative. Wright serum agglutination test was found to be positive at 1/2560 titer. Conclusions: Brucellosis should be kept in mind, especially in the differential diagnosis of the patients with acute hepatitis and cholestasis accompanied by fever.

Keywords

• Brucellosis
• Cholestatic Hepatitis
• Fever

References

1. Ozturk-Engin D, Erdem H, Gencer S, A et al. Liver involvement in patients with brucellosis: results of the Marmara study. Eur J Clin Microbiol Infect Dis 2014; 33: 1253–62.
2. Mazokopakis EE, Papadakis, JA, Kofteridis DP. Unusual causes of intrahepatic cholestatic liver disease. World J Gastroenterol 2007; 13: 1879-82.
3. Cervantes F, Bruguera M, Carbonell J, Force L, Webb S. Liver disease in brucellosis. A clinical and pathological study of 40 cases. Postgrad Med J 1982; 58: 346–50.
4. 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.
5. 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: 469–78.
6. Uluğ M, Celen MK, Ayaz C. An unusual presentation of brucellosis: acute hepatitis. Braz J Infect Dis 2010; 14: 641-2.
7. Ariza J, Gudiol F, Pallares R, et al. Treatment of human brucellosis with doxycycline plus rifampin or doxycycline plus streptomycin. A randomized, double‐blind study. Annals of Internal Medicine 1992; 117: 25-30.
8. Colmenero Castillo JD, Hernandez Marquez S, Reguera Iglesias JM, Cabrera Franquelo F, Rius Diaz F, Alonso A. Comparative trial of doxycycline plus streptomycin versus doxycycline plus rifampin for the therapy of human brucellosis. Chemotherapy 1989; 35: 146‐52.