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523 A Case Report; Brucellosis Triggering Hemolytic Anemia in Glucose-6-Phosphate Dehydrogenase Deficiency
  1. M Özkale1,
  2. Y Özkale1,
  3. A Erbay2,
  4. Ü Paltacı1,
  5. S Asilsoy3
  1. 1Pediatric
  2. 2Pediatric Oncology
  3. 3Pediatric Allergy, Baskent University, Adana, Turkey

Abstract

Background and Aims Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common red blood cell enzyme deficiency in worldwide. It may lead to acute hemolytic anemia triggered by infection, drugs or broad beans (favism). To the best of our knowledge, this is the second reported case of a Turkish patient with brucellosis triggering hemolytic anemia in glucose-6-phosphate dehydrogenase deficiency.

Case A 5-year-old male was admitted our hospital with malaise, fever, abdominal pain, vomiting, jaundice, and darkening of urinary color of one week duration. There were no intake drug, infectious diseases or favism in patient’s history. On physical examination conjunctivae were pale, sclerae were subicteric and the other system examinations were normal. Laboratory examinations revealed leukocyte count of 22800/mm³, hemoglobin of 5.7g/dl, platelets of 596000/mm³, total bilirubin:4.3, indirect bilirubin:3.9 mg/dl, lactate dehydrogenase:1440U/l, AST:190IU/L, ALT:181IU/L. The corrected reticulocyte count was 9.3% and serum haptoglobin level was low (< 10). There was hemoglobinuria in the urinary examination. Direct and indirect Coombs tests were negative. The value of G6PD was low (3.8 IU/g) where osmotic fragility was normal. Serum standard tube agglutination (Wright) test for Brucella sp was positive at a titer of 1/640. The patient was treated by rifampicin and gentamicin.

Conclusion We presented this case report to show that acute brucellosis might trigger an acute hemolytic attack in a patient with underlying G6PD deficiency. This is important especially in countries such as Turkey, where brucellosis is endemic and there is a high frequency of G6PD deficiency in the population.

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