Brucellosis_Pancytopenia_Case_Presentation.pptx

Brucellosis case presentation

1. Brucellosis Presenting with Pancytopenia and Foot Drop A 16-Year-Old Boy – Khyber Teaching Hospital, Peshawar

2. Initial Presentation • 16-year-old boy presented in shock • BP: 70/50 mmHg, HR: 120 bpm, Temp: 101°F • GCS: 15/15, Hb : 4 g/dL • Resuscitated with 3 units blood + 2L IV fluids

3. Clinical Examination • Pallor, fever, hepatosplenomegaly • Neurological: Right foot dorsiflexion weakness (0/5), steppage gait • Cardiac and pulmonary exams: Normal

4. Laboratory & Imaging • Pancytopenia: - Hb: 7 g/dL, WBC: 3,000/ml, Platelets: 75,000/ml • Retic count: Normal, no hemolysis • LFTs, renal function, ECG, echo, CXR: Normal • Ultrasound: Hepatomegaly (12 cm), Splenomegaly (15 cm)

5. Neurological Studies • Nerve conduction study: ↓ amplitude, prolonged latency • EMG: Features of denervation • Initial antibiotic: IV ceftriaxone 1g BID started

6. Diagnosis & Treatment • History: Contact with farm animals • Brucella titers: >1:160 • Blood culture (Day 14): Brucella melitensis • Treatment: - Ceftriaxone, doxycycline, streptomycin (4 weeks) - Then doxycycline + rifampicin (8 weeks)

7. Outcome • After 4 weeks: - Hb: 12 g/dL, WBC: 6,000/ml, Platelets: 210,000/ml - No hepatosplenomegaly or fever • Foot drop improved with physiotherapy - Power improved to 4/5, no visible foot drop • Antibiotics stopped, physiotherapy continued