Table 1 Predominant syndromes identified in a patient according to clinical data, instrumental and laboratory evaluation
From: Presentation of severe brucellosis in 5-year-old boy - challenges and results
Presentation | Clinical signs | |
|---|---|---|
Intoxication syndrome | Subfebrile fever, fatigue, weight loss, excess sweatiness, tachycardia | |
Toxico-allergic dermatitis | Dermatitis (hands, perianal region), itches, hyper- IgE-emia | |
Generalized lymphadenopathy | Cervical, axillary, abdominal, inguinal | |
Secondary endocrine failure | SIADH | Hyponatremia (116–130 mmol/L), serum hypoosmolarity (< 275mOsm/L) with normal dietary salt intake, increased urinary sodium, decreased daily diuresis (250–300 ml/day) |
Hypothyroidism | High TSH and low freeT4 | |
Disorders of calcium metabolism | Decreased calcium, vitamin D levels, recurrent spontaneous fractures | |
Gastrointestinal syndrome | Vomiting, diarrhea, glossitis, rectal prolapse, hematochezia, malabsorption syndrome, duodenitis with intestinal lymphangiectasia, catarrhal bauginitis and sigmoiditis (morphology and immunohistochemical staining) | |
Malabsorption | Deficiency of albumin, K, Fe, Zn, dyslipidemia | |
Arthritis, osteomyelitis | Arthritis of left hip and left knee joints, comminuted fractures of right and left femurs, compression fractures of Th 3–10, L4-5, left femur osteomielitis | |
Meningoencephalitis | Ophthalmoplegia, permanent muscular contractions, stammering, sleep disorders, recurrent attacks of aggression with arterial hypertension, pathological CSF findings (lymphocytic meningitis), MRI data correspond to presentation of encephalitis | |
Immunological disorders | Decreased CD3+, TH-cells, increased CD19+, abnormal ratio CD4+/CD8+, hyperexpression of general IgG, IgM and IgE, recurrent septic episodes | |