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Brucella as a rare cause of cirrhosis in a southern Italy endemic area

Abstract number: 1733_1015

Ascione T., Iannece M., Rosario P., Onofrio M., Quaranta S., Pempinello R.

Background:Brucella infection may be manifest by nonspecific hepatic inflammation or by granulomatous hepatitis. Cirrhosis may be a rare complication of an untreated Brucellosis. Liver and spleen involvement is commonly described during Brucella infection. We reported a case of cirrhosis whose only cause was Brucella infection.

Case report: A 60-year-old woman was referred to our hospital because of gastrointestinal bleeding caused by use of FANS for a 10 months history of unknown origin fever. At admission the patient presented elevated liver enzymes (ALT, GGT, ALP) and elevated bilirubin levels. Low level of albumin (2.5 g/dl) and prothrombin were present. PLT count was 97,000/mmc. HBsAg, HBcAb, anti-HCV, anti-HIV, HBV-DNA and HCV-RNA were negative. Immunologic markers of AIH (ANA, AMA, ASMA, p-ANCA, anti-LKM1) were negative too. Haemochromatosis was excluded of the basis of genotyping testing. No history of alcohol abuse was reported. Abdominal ultrasonography showed enlarged spleen (longitudinal diameters of spleen was 157 mm) and ascites. An endoscopic exam showed gastric ulceration related to FANS use and F2 varices of the distal tract of the oesophagus. Serologic tests for Brucellosis was positive (1/640) and Brucella melitensis grew from blood cultures. The patient was treated with doxycycline and ciprofloxacin for six weeks. Fever disappeared after 2 weeks of therapy. Liver enzymes and bilirubin level improved returning within the normal range after 8 weeks. Three months after the end of therapy an ultrasonographic exam showed disappearance of ascites, reduced spleen longitudinal diameter (132 mm), low platelets (150,000/mmc) and an improved level of albumin (3.7 g/dl).

Conclusions: Although liver involvement is frequent in patients with brucellosis because of both the direct brucella infection effect and the host immune response, progression to cirrhosis is rarely reported. In this case diagnosis of Brucellosis was obtained only after a severe impairment of liver function and portal hypertension appeared. We suggest that brucellosis has to be considered both in cases with criptogenetic cirrhosis or when a progressive worsening of liver functions occurs in patients with an otherwise stable liver disease, if a history of exposure in endemic areas is reported.

Session Details

Date: 31/03/2007
Time: 00:00-00:00
Session name: European Society of Clinical Microbiology and Infectious Diseases
Subject:
Location: ICC, Munich, Germany
Presentation type:
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