A rare presentation of brucellosis: acute cholestatic hepatitis

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.

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