Tolga Altuğ ŞEN, Tevfik DEMİR, Reşit KÖKEN, Afşin Ahmet KUNDAK, Faruk ALPAY

Atipik prezentasyonlu iki çocukluk çağı brusellozis olgusu

Giriş: Brusellozis ülkemizde hala sık görülmekte, zaman zaman seyrek görülen klinik bulgularla prezente olabilmektedir. Olgu 1: On yaşında erkek hasta halsizlik, kilo kaybı, dişeti kanaması nedeniyle kliniğimize başvurdu. Fizik muayenesinde servikal bölgede lenfadenopati, hepatosplenomegali tespit edilen olgunun tam kan sayımında pansitopenisinin olduğu gözlendi. Kemik iliği aspirasyonu incelemesinde, kemik iliği elemanlarının hiposellüler olduğu görüldü. Brusella aglütinasyon titresi 1:1280 olan olgunun kan kültüründe Brusella mellitensis üredi. Pansitopeninin brusellaya yönelik antibiyotik tedavisinden sonra düzeldiği gözlendi. Olgu 2: Dokuz yaşındaki kız olgu acil servisimize birkaç gündür süren çarpıntı nedeniyle başvurdu. Kalp hızı dakikada 136 sayılan olgunun elektrokardiyografisi sinüzal taşikardiyle uyumlu bulundu. Ekokardiyografik incelemesi tamamen normal olan olgunun öyküsünde son 1 aydır kilo kaybı ve kolay yorulma olması üzerine bakılan brusella aglütinasyon titresi 1:1280 bulundu. Kan kültüründe mikroorganizma üremeyen olgunun brusella için başlanılan antiyoterapiye iyi yanıt verdiği, 1 hafta sonra kalp hızının normale döndüğü gözlendi. Tek başına taşikardinin bulunması brusella hastalığı için daha önce bildirilmemiş erken bir bulgu olarak dikkatimizi çekmiştir. Tartışma: Brusella pansitopeninin nadir nedenlerinden biridir; bu nedenle pansitopeninin ayırıcı tanısında akla getirilmelidir. Brusella kardiyovasküler sistemi tutabilen bir hastalık olarak bilinse de daha önce tek bulgunun ateşe bağlı olmayan taşikardi olduğu ve tedaviyle taşikardinin gerilediği bir olgu bildirilmemiş olması olgumuzu ilginç kılmaktadır.

Two unusual presentations of childhood brucella cases

Introduction: Brucellozis is still a common infectious disease in our country and sometimes it may be presented with uncommon clinical manifestations. Case 1: A ten years old male was presented to our clinic with complaints of malaise, weight loss, petechia, and bleeding of gums. On physical examination cervical lymphadenopathy and hepatosplenomegaly had been detected and in complete blood count pancytopenia was found.admitted to our clinic. In bone marrow aspiration hypocellular bone marrow was seen. His Brucella agglutination test was positive at 1:1280 titer and the blood culture was positive for Brucella mellitensis. The pancytopenia was resolved after the antibiotherapy. Case 2: A nine-year-old female was referred to our clinic with tachycardia, who had the cardiac rate of 136/min. The electrocardiography showed sinusal tachycardia and echocardiography was normal, no endocarditis or pericarditis was present. She had complaints of fatigue and lassitude for the last month. Her brucella agglutination test was positive at 1:1280 titer and blood culture was negative. After antibiotherapy her symptoms regressed, cardiac rate decreased to 80-100/min. Isolated tachycardia may be the early manifestaion of brucellosis in children which has not been reported previously. Conclusion: Brucellosis is a rare cause of pancytopenia, it should be considered in differential diagnosis with pancytopenia of children. Brucellosis was known to be involved cardiovascular system, but tachycardia which was not due to fever as the only sign of disease has not been reported previously made our case very interesting.

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