Hepatobiliary involvement in patients with brucellosis

Purpose: Brucellosis is a common infectious disease in many countries worldwide and endemic in some regions. This study aimed to investigate the frequency and characteristics of hepatobiliary involvement in pediatric patients diagnosed with and treated for brucellosis. Materials and Methods: A total of 71 patients who were diagnosed with brucellosis and received treatment between 2022 and 2024 were retrospectively evaluated. Clinical and demographic characteristics, along with laboratory parameters, were collected through a review of the patients' medical records. Rose Bengal test positivity, Wright agglutination titers, and culture results were reviewed. Results: The mean age of the patients was 126 months. Of the patients, 42.3% were females and 57.7% were males. The median aspartate aminotransferase (AST) value was 61.5 IU/L (range: 14-125), and the median alanine aminotransferase (ALT) value was 71 IU/L (range: 6-256). The most common complaints were myalgia, arthralgia, and low back pain, while weight loss and headache were the least frequent symptoms. In terms of physical examination findings, the majority of cases showed normal results, with arthritis being the most common pathological finding. Among the patients, 22 (31%) had elevated ALT levels, 31 (43.7%) had elevated AST levels, and 20 (28.2%) had elevated levels of both AST and ALT. Of the patients (n=20) with AST and ALT levels of >40 IU/L, the standard tube agglutination test (STAT) titer was below 1/1280 in 6 patients and ≥1/1280 in 14 patients. Elevated transaminases returned to normal in all patients after treatment. Hepatomegaly or splenomegaly was detected in 8 (11.2%) and 2 (2.8%) patients, respectively. Conclusion: Brucellosis affects multiple organ systems, and its clinical manifestations can vary widely. Due to frequent occurrence of hepatobiliary involvement in brucellosis, brucellosis should always be considered in the differential diagnosis of elevated transaminases, hepatomegaly, and splenomegaly.