Unusual Presentations of Pediatric Brucellosis: A Case Series from a Single Center

ABSTRACT
Purpose: This study aims to report ten cases of pediatric brucellosis associated with rare and severe complications.
Patients and Methods: Documented clinical symptoms, laboratory test results, diagnosis, and treatment methods were retrospectively reviewed for 10 pediatric patients who presented with rare complications of brucellosis between 2018 and 2021.
Results: One of the patients included in the study had discitis, three had epididymo-orchitis, two had esotropia in one eye, one patient had immune thrombocytopenia, two patients had hemophagocytic lymphohistiocytosis, and one patient was misdiagnosed with juvenile idiopathic arthritis. A common finding in all cases was fever, which was characterized as undulant in all patients. All children positive etiological or serological evidence confirmed the brucellosis infection and the standard tube agglutination test for Brucella was positive at a titer of 1:160 or higher, and blood cultures were also positive in two patients. All patients were treated with age-adjusted doses of rifampicin (10-20 mg/kg/day, orally), in combination with either trimethoprim/sulfamethoxazole (trimethoprim 10 mg/kg/day and sulfamethoxazole 50 mg/kg/day) or doxycycline (4.4 mg/kg/day, orally). Seven patients received additional treatment with gentamicin (5-7.5 mg/kg/day, intravenously) and ceftriaxone (100 mg/kg/day) was added to the treatment in two patients. One of the two patients who developed hemophagocytic lymphohistiocytosis was treated in the intensive care unit, and both patients received additional treatment recommended for hemophagocytic lymphohistiocytosis [intravenous immunoglobulin 1 gr/kg/day, for 2 days; dexamethasone 10 mg/m2 /day] alongside brucellosis treatment. Eventually, nine patients were discharged in good health, while one patient died as a result of complications.
Conclusion: In regions where Brucella infection is prevalent, it is important to consider that clinical manifestations in pediatric patients with unusual complications may be associated with brucellosis, warranting a careful differential diagnosis to distinguish it from other diseases.
Keywords: Brucellosis, children, discitis, epididymo-orchitis, hemophagocytic lymphohistiocytosis, immune thrombocytopenia, juvenile idiopathic arthritis, neurobrucellosis