Severe Thrombocytopenia and Leukopenia as the Initial Manifestations of Brucella melitensis Bacteremia: A Case Report.

Brucellosis is a zoonotic infection with diverse clinical manifestations that frequently delay diagnosis because of its nonspecific presentation. Hematologic abnormalities have been described in affected patients; however, severe thrombocytopenia remains an uncommon finding. We present the case of a 50-year-old woman who was admitted with a four-day history of fever up to 39°C, diffuse abdominal pain, vomiting, and secretory diarrhea. Initial laboratory evaluation revealed leukopenia (2.7 × 10³/μL), severe thrombocytopenia (29 × 10³/μL), hyponatremia, and elevated liver enzymes. The patient remained hemodynamically stable and showed progressive clinical improvement with supportive management. As part of the etiologic workup, two independent blood cultures yielded Brucella melitensis, establishing the diagnosis of systemic brucellosis. Further evaluation identified a history of unpasteurized milk consumption, and the 2-mercaptoethanol test was positive. Treatment with doxycycline and rifampin was initiated, and the patient subsequently demonstrated progressive clinical recovery, recovery of leukocyte and platelet counts, and improvement in biochemical abnormalities. This case highlights the importance of considering brucellosis in the differential diagnosis of patients presenting with acute febrile illness, severe thrombocytopenia, and leukopenia, even in the absence of classic focal manifestations of the disease.