布鲁菌病继发噬血细胞综合征1例并文献复习

目的 了解布鲁菌病继发噬血细胞综合征的临床特征.方法 对1例布鲁菌病继发噬血细胞综合征患者的临床表现、实验室检查结果、治疗和预后进行分析,并以"brucella and hemophagocytic syndrome""hemophagocytic lymphohistiocytosis"为主题词检索PubMed数据库...

Hemophagocytic syndrome secondary to brucellosis:one case report and literature review

Objective To understand the clinical characteristics of hemophagocytic syndrome secondary to brucellosis.Methods The clinical manifestations,laboratory results,treatment and outcome in a patient with hemophagocytic syndrome secondary to brucellosis were reviewed.Meanwhile,CNKI,Wanfang,VIP,and PubMed databases were searched with“brucella and hemophagocytic syndrome”“hemophagocytic lymphohistiocytosis”as the search terms to retrieve the case reports which published from 2000 to 2020.The clinical data of patients with hemophagocytic syndrome secondary to brucellosis were summarized and discussed.Results The 59-year-old female patient developed recurrent diarrhea,fever,and hyperhidrosis.The hematological tests showed pancytopenia.Bone marrow smear showed hemophagocytic cells,Brucella melitensis was cultured and identified from blood.The patient improved after anti-brucellosis treatment.She was finally diagnosed with hemophagocytic syndrome secondary to brucellosis.Six additional reports in Chinese and 7 in English were retrieved.A total of 18 patients(14 males,4 females,2.5 to 73 years of age)were analyzed.Fever and/or chills,fatigue,gastrointestinal symptoms,liver/spleen/lymph node enlargement were the main manifestations.The diagnosis was confirmed in 16 cases and clinically supported in 2 cases.Seven patients were treated with drugs targeting both brucellosis and hemophagocytic syndrome.Nine patients received treatment for brucellosis alone.The treatment was unknown in the remaining 2 patients.Most patients(16/17)were improved after treatment(1 case with unknown outcome).Conclusions The clinical symptoms of brucellosis may be atypical in some patients,who may develop hemophagocytic syndrome.Good outcome is expected in most cases of hemophagocytic syndrome secondary to brucellosis after comprehensive treatment,including anti-brucellosis and/or immunomodulation.