A rare presentation of peripheral edema and ascites in a 10-year-old child with brucellosis: A case report. (January 2022)

• Record Type: Journal Article
• Authors: Shebli, Baraa; Batal, Rand; Chihab, Mtanyous; Zammar, Leen; Warrak, Bayan; Allouzi, Sana; Abdullah, Manar
• Is Part Of: Annals of medicine and surgery. Volume 73(2022)
• Publication Date: 2022-01
• Subjects: CLS Capillary Leak Syndrome -- ANA Anti Nuclear Antibody -- ASMA Anti Smooth Muscle antibody -- LKM Liver Kidney Michrosomal; Brucellosis -- Ascites -- Peripheral edema; Surgery -- Periodicals; Medicine -- Periodicals; General Surgery -- Periodicals; Education, Medical -- Periodicals; Periodicals; 617
• DOI: 10.1016/j.amsu.2021.103196
• Languages: English
• ISSNs: 2049-0801

Abstract

Abstract: Introduction: and importance: Brucellosis is a common infection in Mediterranean region that manifests with various symptoms. Brucellosis should be considered as a possible cause of recurrent fever even if the symptoms are not suggestive of brucellosis. Case presentation: We report a case of 10-year-old child with no significant past medical history who presented with a 4-day period peripheral edema and ascites without fever, arthralgia or abdominal pain. Clinical discussion: Proper investigations showed normal cardiac and renal functions; ultrasonography showed no portal vein hypertension. Albumin and total protein were also within normal. Complete blood count revealed pancytopenia; bone marrow aspiration and biopsy revealed hypercellularity that could be attributed to hypersplenism as a possible cause. Liver biopsy revealed non-specific inflammatory findings and also did not lead to a definite diagnosis. While broadening the scope of deferential diagnosis in order to reach a final diagnosis, Wright serum agglutination was tested positive (1/640) and we diagnosed a brucellosis infection. A proper management with Antibiotics ensued; the patient had uneventful recovery on treatment until complete clinical and imaging resolution of signs and symptoms. Conclusion: Although brucellosis is considered a multi-systemic disease with atypical presentations, early diagnosis of brucellosis with management causes rapid recovery and favorable prognosis. We report a case of ascites and edema in context of Brucella infection which was completely resolved after treatment. This condition is rare especially in previously healthy child and after excluding other possible causes. We aim to share our case to keep brucellosis in mind as a differential diagnosis when dealing with infectious diseases with non-specific symptoms. Highlights: Brucellosis has various gastrointestinal and hematological complications beside the classic constitutional symptoms. Brucellosis causes ascites with/without a concomitant hepatobiliary disease. Our case is caused by direct immune reaction. Brucellosis causes peripheral edema due to low albumin or CLS; however, these two etiologies were absent in our case. Hematological complications are anemia, leukopenia and less commonly pancytopenia. Ruling out other diseases is essential. Brucellosis should be taken into account as a differential diagnosis in infectious diseases especially in endemic areas.