Acute Brucellosis with Pancytopenia and Maculopapular Rash

Human brucellosis is common in developing countries and is a multi-system disease with a broad spectrum of clinical manifestations. Cutaneous lesions associated with brucellosis have been rarely reported in the literature. Here we present a case of a 32-year-old man with history of consumption of cheese made from raw milk seen with occurrence of pancytopenia and diffuse maculopapular rash during the course of Brucella infection. Physical examination showed fever, splenomegaly, mild hepatomegaly and pruritic maculopapular exanthema over the trunk, arms and legs. Laboratory tests revealed pancytopenia. Parasitic examinations and serologic tests for syphilis, salmonellosis, rickettsiasis, toxoplasmosis, Epstein-Barr virus, human immunodeficiency virus, and hepatitis B and C viruses were negative. There was no history of drug consumption.The Brucella agglutination test titer was 1/1280 and histological examination of skin biopsy showed lymphohistiocytic perivascular infiltrates in the upper dermis.Lesions were interpreted as Brucellar dermatitis , The patient was subsequently treated with oral doxycycline and rifampin and was discharged in good health. If there is suspicion of exposure to infected food products, brucellosis should be included in the differential diagnosis of pancytopenia in Brucella-endemic areas; there may be skin lesions other than purpura that can accompany thrombocytopenia.