Acute brucellosis with myelodysplastic syndrome presenting as pancytopenia and Fever of unknown origin

Brucellosis causing bone marrow aplasia in an 11-year-old patient with complete recovery after treatment

Brucellosis is one of the most prevalent zoonotic infections in the Middle East. The disease may present with a range of symptoms from a simple febrile illness to severe invasive infections affecting different organ systems (meningitis, osteomyelitis). In this paper we present an eleven-year-old girl who was diagnosed with “idiopathic bone marrow aplasia” and planned for hematopoietic stem cell transplant (HSCT), when pre-transplant work-up showed high brucella titers. The patient was started on doxycycline, rifampin and gentamicin initially, with discontinuation of the latter 3 weeks into therapy. She recovered completely after 8 months of treatment.

Antibiotic-Resistant Pyrexia of Unknown Origin: An Unusual Presentation of Myelodysplastic Syndrome

A 74-year-old male presented to the emergency department (ED) with complaints of high-grade fever, productive cough, and difficulty breathing for three weeks, and a significant weight loss in the past six months. Despite a detailed investigation, diagnosis could not be achieved. Multiple empiric regimens were tried but no response was observed. Bone marrow biopsy was conducted after suspicious peripheral film result, which concluded that the patient was having myelodysplastic syndrome. Although pyrexia of unknown origin has a diverse group of diseases to evaluate for, and rare entities are difficult to diagnose, meticulous evaluation may give significant evidence for targeted diagnostic workup.

A man with recurrent fever, arthritis, and rashes-brucellosis? A case report

Background

We report a rare case of chronic brucellosis accompanied with myelodysplastic syndrome and neutrophilic dermatosis, which to the best of our knowledge, has never been reported.

Case presentation

A young man was admitted to our hospital complaining of recurrent fever, arthritis, rashes and anemia. He had been diagnosed with brucellosis 6 years prior and treated with multiple courses of antibiotics. He was diagnosed with myelodysplastic syndrome and neutrophilic dermatosis following bone marrow puncture and skin biopsy. After anti-brucellosis treatment and glucocorticoid therapy, the symptoms improved.

Conclusions

Clinicians should consider noninfectious diseases when a patient who has been diagnosed with an infectious disease exhibits changing symptoms.

Unusual Maculopapular Rash on the Scalp of a Patient with Mediterranean Spotted Fever

OBJECTIVE

To report a rare case of maculopapular rash on the scalp in a patient with Mediterranean spotted fever (MSF).

CLINICAL PRESENTATION AND INTERVENTION

A 58-year-old woman with breast cancer and chemotherapy-induced alopecia contracted MSF. Her clinical features were typical, except for a maculopapular rash covering the scalp. The diagnosis of MSF was confirmed by immunofluorescent assay. The disease had a favorable course and the patient was discharged in good condition.

CONCLUSION

The rash on the scalp described in this report enriches our knowledge on the clinical characteristics of MSF.

Liver tuberculosis presenting as an uncommon cause of pyrexia of unknown origin: positron emission tomography/computed tomography identifies the correct site for biopsy

OBJECTIVE

To identify the correct site to biopsy in a case of pyrexia of unknown origin (PUO) caused by hepatic tuberculosis (TB).

CLINICAL PRESENTATION AND INTERVENTION

A 58-year-old man who developed hepatic TB presented with PUO. Ultrasonography (US) and computed tomography (CT) of the abdomen showed only calcifications in the liver, and positron emission tomography (PET)/CT showed diffuse increased metabolic activity in addition to focal areas of increased activity. A diagnosis of hepatic TB was confirmed by histological examination of liver tissues and interferon-γ release assays (IGRAs of T-SPOT/TB). The patient was treated with 4 anti-tubercular therapies (rifampicin, isoniazid, ethambutol and pyrazinamide). At the 3-month follow-up, the patient was disease free as confirmed by abdominal US.

CONCLUSION

PET/CT was helpful in identifying a site to biopsy that led to the correct diagnosis.