CLINICAL BRIEF Hemophagocytic Syndrome in a Child with Brucellosis Nivedita Mondal & R. Suresh & N. Srinivas Acharya & Ira Praharaj & B. N. Harish & S. Mahadevan Received: 6 November 2009 / Accepted: 12 May 2010 / Published online: 8 October 2010 # Dr. K C Chaudhuri Foundation 2010 Abstract The authors report case of a two and half years old female child presented with fever for one month with hepatosplenomegaly. Though the child had been symptom- atic for a prolonged period, she did not appear very unwell at presentation. However, after admission there was sudden rapid deterioration of her clinical status. Investigations revealed hemophagocytosis with brucella infection. Keywords Fever . Hemophagocytosis . Brucellosis A two and half yrs old girl was brought with complaint of low grade intermittent fever with no specific diurnal variation for one month. There was history of tuberculosis in a family member. No other significant history was obtained. The child’ s weight was 10 kg and height was 80 cm, both of which were lower than the 3rd centile for age and gender according to the WHO child growth standards. She had pallor, small submandibular lymph nodes, firm hepatomegaly of 3 cm and splenomegaly of 3 cm. The initial hemogram showed microcytic hypo- chromic anemia with normal total leucocyte count and platelet counts. There were no parasites in the peripheral smear, Parasite–F test for malarial antigen was negative. ESR was raised, 80 mm at the end of 1st h. Mantoux and gastric aspirate for acid fast bacilli were negative and chest radiograph was normal. Her Widal test was negative. Two days after admission she started having high spiking fever along with oral mucosal ulcers and rapid enlargement of the liver and spleen. She had developed pancytopenia (Hb=5.7 g/dl, TLC= 2600/mm 3 , Platelet count=7,000/mm 3 ), her PT was normal (INR=1.09), but liver enzymes were raised- AST=260 IU/L, ALT=74 IU/L with normal ALP (349 IU/L). She had hypofibrinogenemia (1.2 g/dl), high ferritin (>1500 μg/L) and high triglycerides (617 mg/dl) and was FDP negative. Blood cultures on three occasions were sterile. Bone marrow examination was done, which revealed hemophagocytosis (Fig. 1). The bone marrow culture on the seventh day of incubation grew Brucella melitensis, which was confirmed by agglutination with specific antisera. Standard agglutination test was positive (Titre:1282). Retrospectively, the authors found that the child had been taking fresh unboiled goat’ s milk as a remedy for intestinal hurry and poor weight gain fifteen days before the onset of illness. She was treated with rifampicin and cotrimoxazole, to which she responded well with subsidence of fever and normalization of cell counts in about seven days. Discussion Brucellosis is a zoonosis which is common in our country. Brucella melitensis which was the organism isolated in the present case, is the most common cause of human disease. It is also known to cause the most serious human infections. Consumption of unpasteurised milk or milk products is the most common way of acquiring infection, a practice which is still common in our country. The manifestations of brucellosis can be protean, involving almost any system. However, the commonest presenting feature is fever [1]. In this case, as part of investigations for fever and hepatos- plenomegaly with pancytopenia, blood and bone marrow N. Mondal (*) : R. Suresh : S. Mahadevan Department of Pediatrics, JIPMER, Puducherry, India e-mail: nivedita_m8@yahoo.com N. S. Acharya : I. Praharaj : B. N. Harish Department of Microbiology, JIPMER, Puducherry, India Indian J Pediatr (2010) 77:1434–1436 DOI 10.1007/s12098-010-0221-z