Patient1
A 38-year-old Iranian man, previously healthy, presented to the emergency department around September 2021 with fever, significant weight loss, sweating, and anorexia, from 2 months ago. Hematologic and biochemical parameters including Hemoglobin Test (Hb): 9.5 (Reference Value: 12.5-16.5 g/dL), White Blood Count (WBC):4550 (Reference Value: 4.0-10 × 1000 mm3), Platelet Count (PLT): 165000 (Reference Value: 150-450 × 1000 mm3), Erythrocyte Sedimentation Rate (ESR): 45 (Reference Value: 0-15 mm/hr), Aspartate Aminotransferase (AST):45 (Reference Value: up to 40 IU/L ), Alkaline Phosphatase (ALP): 213 (Reference Value: 70-330 IU/L), Alanine Transaminase (ALT): 40 (Reference Value: up to 37 IU/L ), and Lactate Dehydrogenase (LDH): 650 IU/L (Adult < 480) were reported. Interestingly, investigation of clinical abdominal by computerized tomography (CT) scan revealed mesenteric lymphadenopathy. In continued diagnosis, the Brucella agglutination test was positive. Wright: 1/320, 2ME: 1/160, and Coombs Wright: 1/320.
Patient 2
A 24-year-old Iranian pregnant woman, previously healthy, presented to the emergency department around February 2022 with fever, submandibular lymphadenopathy, and anemia from 4 weeks ago. Hematologic and biochemical parameters including (Hb): 11.5 (Reference Value: 12.5-16.5 g/dL), WBC: 10990 (Reference Value: 4.0-10 × 1000 mm3), PLT: 177000 (Reference Value: 150-450 × 1000 mm3), ESR: 45 (Reference Value: 0-15 mm/hr), AST: 35 (Reference Value: up to 40 IU/L ), ALP:172 (Reference Value: 70-330 IU/L), ALT: 38 (Reference Value: up to 37 IU/L ), and LDH:320 IU/L (Adult < 480) were reported. Submandibular ultrasonography displayed lymphadenopathy, in continuing, after consultation with an infectious disease specialist, the Brucella agglutination test was checked. These tests were positive results with tetration Wright: 1/160,2ME: 1/80, Coombs Wright: 1/160. After, Brucella diagnosis of patient, treatment were started. As described earlier in a review report, association hematologic malignancy with brucellosis have been observed, more than other cancer (5). Therefore, a biopsy of lymphadenopathy in order to investigation of hematologic malignancy was performed, which was reactive.
Patient 3
A 64-year-old Iranian woman, previously healthy, presented to the emergency department around May 2022 with fever fatigue, sweating, and anorexia. Laboratory tests revealed (Hb): 9.8 (Reference Value: 12.5-16.5 g/dL), WBC: 2000 L (Reference Value: 4.0-10 × 1000 mm3), PLT: 10000 Reference Value: 150-450 × 1000 mm3), ESR: 35 (Reference Value: 0-15 mm/hr), AST: 131 (Reference Value: up to 40 IU/L ), ALP: 283 (Reference Value: 70-330 IU/L), ALT:89 (Reference Value: 70-330 IU/L), and LDH; 1220 IU/L (Adult < 480) were reported. In continuing, abdominal ultrasonography and CT indicated splenomegaly (165 mm) with a negative result for the Brucella agglutination test. More evaluation for hematology malignancy through Bone Marrow Aspirate (BMA) and biopsy was reported in hypercellular marrow with trilineage hematopoiesis and progressive maturation. Any fibrosis, lymphoid nodules, and increased megakaryocytes were not shown. In PET SCAN; nonspecific splenomegaly was reported and splenic biopsy was recommended but based on thrombocytopenia splenic biopsy was not done. Finally, during repeat consultation with an infectious disease specialist, the Brucella agglutination test was tested again, 3 weeks after the first test, that positive results including Wright: 1/640, 2ME: 1/320, and Coombs Wright: 1/640 were reported.
The study protocol was approved by the Arak University of Medical Sciences Research Ethics Committee (IR.ARAKMU.REC.1401.088). All procedures performed in this study were in accordance with the 1964 Helsinki Declaration and its later amendments. Also, informed consent was obtained from all individual participants included in the study at the time of sample collection in accordance with the above-mentioned ethical standards.