Rahmet GÜNER, Aydan KILIÇARSLAN, İmdat DİLEK, Sema AKINCI, İmran HASANOĞLU, Samet YAMAN, Ayşe KALEM KAYA, Şule Mine BAKANAY ÖZTÜRK, Aysun ŞENTÜRK YILMAZ, Mehmet GÜNDÜZ

Bilinmeyen Ateş Etiyolojisinde Girişimsel Hematolojik Tetkiklerin Yeri

Amaç: Nedeni bilinmeyen ateş (NBA) etiyolojisi çoğu zaman klinisyenleri uğraştıran, tanı için invazivişlemler gerektiren klinik bir tablodur. Kemik iliği kültürü ve biyopsisi ile lenf nodu biyopsisi bu amaçlatercih edilen invaziv girişimlerdir. Çalışmamızda NBA etiyolojisi araştırdığımız hastalarımıza ait buincelemelerin tanıdaki rolü ve sonuçları tartışılmıştır.Materyal ve Metot: Ankara Atatürk Eğitim ve Araştırma Hastanesi Enfeksiyon Hastalıkları Kliniği’ndeNBA etiyolojisine yönelik kemik iliği (Kİ) kültürü ve biyopsisi amacı ile Hematoloji ile konsülte edilen velenf nodu biyopsisi değerlendirilen hastalar incelenerek, tanıda bu invaziv girişimlerin rolüdeğerlendirilmiştir.Bulgular: Kemik iliği kültürü‐biyopsisi yapılan 18 erkek, 14 kadın, toplam 32 hastadan alınan kemik iliğikültürlerinin altısında üreme saptandı. İki hastada eş zamanlı olarak hem kan, hem de kemik iliğikültüründe üreme vardı. İki hastanın sadece kemik iliği kültüründe Brucella spp. üredi.Kemik iliğibiyopsilerinden 24’ü (%75,00) normoselüler, 6’sı (%19,00) hiperselüler, biri (%3,00) lenfoma tutulumugösteren kemik iliği ve bir diğeri ise poliklonal plazma hücre artışı gösteren hiposelüler kemik iliğişeklinde raporlandı. Fizik muayenede lenfadenopatisi saptanan dokuz hastaya lenf nodu biyopsisiyapıldı. Lenf nodu biyopsileri ile bir hastada Leishmania spp., bir hastada EBV ve iki hastada diffüzbüyük B hücreli non‐Hodgkin lenfoma (NHL) saptandı.Sonuç: NBA etiyolojisinde kemik iliği biyopsisi ve kültürü ve lenf nodu biyopsisi invaziv tanısalgirişimler olup, kemik iliği tutulumu ile seyreden brusella gibi zoonotik enfeksiyonlar başta olmak üzerelösemi, lenfoma, tüberküloz gibi durumları ortaya koymada altın standart testtir. NBA etyolojisiaraştırılırken girişimsel hematolojik işlemlerin değeri göz ardı edilmemelidir. Birinci basamak hekimleri,bu işlemlerin gerekliliği ve zamanlaması konusunda bilgi sahibi olmalıdır.

The Place of Interventional Hematologic Investigations in Unknown Fever Etiology

Abstract Objectives: Fever of unknown origin (FUO) is a usually challenging clinical condition for physicians. The diagnostic work‐up requires invasive procedures including culture of bone marrow aspirates and bone marrow/lymph node biopsies. In this study, we have investigated the results of diagnostic procedures employed for the work‐up of FUO. Materials and Methods: Patients who were requested hematological consultation for bone marrow aspiration for culture during the work‐up for FUO in the Infectious Diseases Department of Ankara Atatürk Training and Research Hospital were included in the study. Patients with detected lymphadenopathies during physical examination had also underwent pathological investigation of bone marrow and lymph node biopsies. Results: Bone marrow cultures revealed positive results in 6 out of 32 patients(18 male and 14 female). Two patients had simultaneous positivity of both blood and bone marrow cultures. Brucella spp. was detected in bone marrow cultures of two other patients. Among the bone marrow biopsies 24(75.00%) were normocellular, 6(19.00%) were hypercellular, 1(3.00%)revealed lymphoma involvement and 1(3.00%) revealed polyclonal expansion of plasma cells. Nine patients with with lymphadenopathies in physical examination were performed lymph node biopsies. Lymph node biopsies demonstrated Leishmania spp. in 1 patient, EBV in 1 patientand diffuse large B‐celllymphoma in 2 patients. Conclusion: Bone marrow biopsy and culture and lymph node biopsy are invasive diagnostic tests for the work‐up of FUO. Bone marrow culture is the golden standard for the diagnosis of zoonotic infections including brucellosis and granulomatous infections including tuberculosis, as well as infiltration with leukemia and lymphoma. The value of interventional hematological procedures should not be underestimated during the work‐up of FUO. The primary care physicians must be aware of this necessity and of the timing for these procedures.

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