An unusual presentation of acute brucellosis with thrombocytopenia and maculopapular rash

Human brucellosis is common in developing countries and a multi-system disease with a broad spectrum of clinical manifestations. Cutaneous lesions associated with brucellosis have been rarely reported in the world literature. Here we present the case of a 69-year-old woman with history of consumption of cheese made from raw milk seen with occurrence of thrombocytopenia and diffuse maculopapular rash during the course of Brucella infection. Physical examination showed a pruritic maculopapular exanthema over the trunk, arms and legs. Laboratory tests revealed severe thrombocytopenia with platelet count of 15x109/L. Body temperature was normal. Parasitic examinations and serologic tests for syphilis, salmonellosis, rickettsiae, toxoplasma, Epstein-Barr virus, human immunodeficiency virus, and hepatitis B and C viruses were negative. The Brucella agglutination test titer was 1/2.560 and the skin lesions were interpreted as brucellar dermatitis. The patient was subsequently treated with oral doxycycline and rifampicin 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 thrombocytopenia in Brucella-endemic areas; there may be skin lesions other than purpura that can accompany thrombocytopenia