Agustos 2019
Kolestaz klinigi ile basvuran akut brusella hepatiti olgusu
A case of acute brucella hepatitis presenting with cholestase clinic
- Ana Sayfa
- Sayılar
- Agustos 2019
- Kolestaz klinigi ile basvuran akut brusella hepatiti olgusu...
Özet
Bruselloz; enfekte hayvanin sivilarinin direk insana temasi veya enfektehayvandan elde edilmis pastörize edilmeyen süt ve peynirden insanabulasan zoonotik bir enfeksiyondur. Bruselloz da gastrointestinal tutulum vakalarin yüzde 3-6’sinda klinik hepatit seklinde seyreder ve akuthepatit nadir karsilasilan bir durumdur. 62 yasinda bayan hasta halsizlik,ates ve skleralarda sararma sikayetleri ile klinigimize basvurdu. Hastaakut kolanjit ön tanisi ile klinige yatirildi. Hastaneye ilk basvuru laboratuvar degerleri lökosit: 9.35 109/L, hemoglobin: 11,5 g/dL, platelet:139 109/L, uluslararasi normallestirilmis oran 0.95, sedimantasyon 35mm, C-reaktif protein: 9 mg/dL, albümin 2.5 g/dL, total bilirübin/direkt bilirübin 7.4/5.8 mg/dL, aspartat aminotransferaz: 784 U/L, alaninaminotransferaz: 418 U/L, alkalen fostafataz: 363 U/L, gama glutamiltranspeptidaz: 210 U/L, laktat dehidrogenaz: 737 U/L idi. Yapilan batinultrasonografide karaciger, intrahepatik safra yollari ve koledok normalizlendi. Hastanin klinik takiplerinde ondülan ates paterni mevcuttu.Çalisilan Brusella Rose Bengal Lam Aglütinasyon testi pozitif bulunduve Brusella Coombs Aglütinasyon testi 1/1280 titrede pozitif saptandi. Hastanin kan kültürlerinde de Brucella üremesi oldu. Hastaya oraldoksisiklin 100 mg 2 x 1 ve rifampisin 300 mg 1 x 2 tedavisi alti haftaverildi. Hastanin takiplerde klinik ve laboratuvar tablosu düzeldi. Özellikle atesin eslik ettigi akut hepatit ve kolestaz hastalarinda ayirici tanidaBrusellozisin düsünülmesi önerilir.
Abstract
Brucellosis is a zoonotic infection that is transmitted to humans throughthe direct contact of fluids of the infected animal or through the consumption of nonpasteurized milk or cheese obtained from the infectedanimal. In brucellosis, gastrointestinal involvement occurs as clinicalhepatitis in 3%–6% of cases, and acute hepatitis is a rare condition.A 62-year-old female patient presented to our clinic with complaints ofweakness, fever, and yellowing of the sclera. The patient was hospitalized with a preliminary diagnosis of acute cholangitis. At the first admission, the laboratory parameters were white blood cells 9.35 x 109/L,hemoglobin: 11.5 g/dL, platelets: 139 x 109/L, international normalizedratio: 0.95, sedimentation 35 mm, C-reactive protein: 9 mg/dL, albumin 2.5 g/dL, total bilirubin/direct bilirubin 7.4/5.8 mg/dL, aspartateaminotransferase 784 U/L, alanine aminotransferase 418 U/L, alkalinephosphatase 363 U/L, gamma-glutamyl transferase 210 U/L, and lactate dehydrogenase 737 U/L. Abdominal ultrasonography revealednormal findings in the liver, intrahepatic bile ducts, and choledochus.During the clinical follow-up, the patient had insidious fever patterns.Brucella Rose Bengal Lam Agglutination test showed a positive result,and Brucella Coombs Agglutination test also demonstrated a positiveresult at 1:1280 titer. In addition, brucella was detected in the bloodcultures of the patient. Oral doxycycline 100 mg 2 x 1 and rifampicin300 mg 1 x 2 were administered for 6 weeks, after which the patientshowed improvement in the clinical and laboratory findings. Therefore,it is recommended to consider brucellosis in the differential diagnosis,especially in patients with fever having acute hepatitis and cholestasis.
