Atipik prezentasyonlu brusellozis olgusu: Akut hepatit

Bruselloz geliþmekte olan ülkelerde halen sýk rastlanan bir hastalýktýr. Brusella enfeksiyonu Türkiye’nin Doðu ve Güneydoðu bölgelerinde endemik olarak görülmektedir. Ülkemizde yýlda yaklaþýk 18.000 yeni olgu tespit edilmektedir. Bruselloz yaygýn tutulumu olan bir hastalýktýr. Birçok organ veya sistem tutulabilir. Gastrointestinal sistemde nadiren hepatit enfeksiyonlarýna neden olabilir. Biz de bu yazýda çocuk kliniðimizde takip ettiðimiz
brusellaya baðlý bir akut hepatit olgusunu sunuyoruz. On dört yaþýnda erkek hasta yaygýn kas aðrýlarý, halsizlik, kilo kaybý, yüksek ateþ ve kusma nedeniyle yatýrýldý. Yapýlan fizik muayenede cilt, skleralar ve mukozalar ikterik, karaciðer 4-5 cm palpabl idi. Laboratuvar incelemede, AST: 1310 U/L, ALT: 682 U/L, GGT: 744 U/L, ALP: 402 U/L, total bilirubin: 4,2 mg/dL, direkt bilirubin: 1,9 mg/dL idi. Viral markerler negatif idi. Brusella tüp aglütinasyon testi pozitif (1/320) olan ve kan kültüründe Brucella spp. üreyen hastaya streptomisin ve doksisiklin ile tedaviye baþlandý. Tedavinin 3. gününden itibaren klinik cevap alýnmaya baþlandý. Tedavisinin 21. gününde AST, ALT ve bilirubin deðerleri normal olan hasta taburcu edilerek tedavisi 8 haftaya tamamlandý. Olgu sunumunun amacý ülkemiz gibi brusella enfeksiyonun endemik olduðu bölgelerde akut hepatit ayýrýcý tanýsýnda brusellozun önemini vurgulamaktýr.

Unusual presentation of brucella case: Acute hepatitis

Brucellosis is a still frequently encountered disease in developing countries. Brucella infection is seen endemically in East and Southeast Turkey. Each year approximately 18.000 new cases are reported in our country. Brucellosis infects multiple systems within the body. Many organs and systems may be involved in brucella infection. Gastrointestinal involvement in brucellosis may rarely result in hepatitis. We present herein an acute hepatitis case due to brucella. A 14-year-old male patient presented with diffuse myalgia, weight loss, fever, vomiting, and fatigue. Physical examination revealed that skin, sclera and mucosal surfaces were all icteric, and the liver was palpable 4-5 cm below the costal margin. Laboratory investigations revealed aspartate aminotransferase (AST) 1310 U/L, alanine aminotransferase (ALT) 682 U/L, gamma glutamyl transpeptidase (GGT) 744 U/L, alkaline phosphatase (ALP) 402 U/L, total bilirubin 4.2 mg/dl, and conjugated bilirubin 1.9 mg/dl. Viral markers for hepatitis A, B and C were all negative. Brucella tube agglutination test was positive (1/320) and hemoculture revealed Brucella spp. Streptomycin and doxycycline treatment was initiated. Clinical response was noted within the 3rd day of treatment, and ALT, AST and total bilirubin levels returned to their normal levels on the 21st day of the treatment. Treatment lasted for 8 weeks. We present this case to underline that brucellosis should be kept in mind in the differential diagnosis of acute hepatitis, especially in regions where brucellosis is endemic.