Atipik Prezentasyonlu İki Çocukluk Çağı Brusellozis Olgusu-Olgu Sunumu (original) (raw)

Brusellozis ülkemizde hala s›k görülmekte, zaman zaman seyrek görülen klinik bulgularla prezente olabilmektedir. Olgu 1: On yafl›nda erkek hasta halsizlik, kilo kayb›, difleti kanamas› nedeniyle klini¤imize baflvurdu. Fizik muayenesinde servikal bölgede lenfadenopati, hepatosplenomegali tespit edilen olgunun tam kan say›m›nda pansitopenisinin oldu¤u gözlendi. Kemik ili¤i aspirasyonu incelemesinde, kemik ili¤i elemanlar›n›n hiposellüler oldu¤u görüldü. Brusella aglütinasyon titresi 1:1280 olan olgunun kan kültüründe Brusella mellitensis üredi. Pansitopeninin brusellaya yönelik antibiyotik tedavisinden sonra düzeldi¤i gözlendi. Olgu 2: Dokuz yafl›ndaki k›z olgu acil servisimize birkaç gündür süren çarp›nt› nedeniyle baflvurdu. Kalp h›z› dakikada 136 say›lan olgunun elektrokardiyografisi sinüzal taflikardiyle uyumlu bulundu. Ekokardiyografik incelemesi tamamen normal olan olgunun öyküsünde son 1 ayd›r kilo kayb› ve kolay yorulma olmas› üzerine bak›lan brusella aglütinasyon titresi 1:1280 bulundu. Kan kültüründe mikroorganizma üremeyen olgunun brusella için bafllan›lan antiyoterapiye iyi yan›t verdi¤i, 1 hafta sonra kalp h›z›n›n normale döndü¤ü gözlendi. Tek bafl›na taflikardinin bulunmas› brusella hastal›¤› için daha önce bildirilmemifl erken bir bulgu olarak dikkatimizi çekmifltir. Tart›flma: Brusella pansitopeninin nadir nedenlerinden biridir; bu nedenle pansitopeninin ay›r›c› tan›s›nda akla getirilmelidir. Brusella kardiyovasküler sistemi tutabilen bir hastal›k olarak bilinse de daha önce tek bulgunun atefle ba¤l› olmayan taflikardi oldu-¤u ve tedaviyle taflikardinin geriledi¤i bir olgu bildirilmemifl olmas› olgumuzu ilginç k›l-maktad›r. (Güncel Pediatri 2010; 8: 39-43) Anahtar kelimeler: Brusellozis, pansitopeni, çocuk, taflikardi SUMMARY Introduction: Brucellozis is still a common infectious disease in our country and sometimes it may be presented with uncommon clinical manifestations. Case 1: A ten years old male was presented to our clinic with complaints of malaise, weight loss, petechia, and bleeding of gums. On physical examination cervical lymphadenopathy and hepatosplenomegaly had been detected and in complete blood count pancytopenia was found.admitted to our clinic. In bone marrow aspiration hypocellular bone marrow was seen. His Brucella agglutination test was positive at 1:1280 titer and the blood culture was positive for Brucella mellitensis. The pancytopenia was resolved after the antibiotherapy. Case 2: A nine-year-old female was referred to our clinic with tachycardia, who had the cardiac rate of 136/min. The electrocardiography showed sinusal tachycardia and echocardiography was normal, no endocarditis or pericarditis was present. She had complaints of fatigue and lassitude for the last month. Her brucella agglutination test was positive at 1:1280 titer and blood culture was negative. After antibiotherapy her symptoms regressed, cardiac rate decreased to 80-100/min. Isolated tachycardia may be the early manifestaion of brucellosis in children which has not been reported previously. Conclusion: Brucellosis is a rare cause of pancytopenia, it should be considered in differential diagnosis with pancytopenia of children. Brucellosis was known to be involved cardiovascular system, but tachycardia which was not due to fever as the only sign of disease has not been reported previously made our case very interesting.

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