Treatment of Severe Refractory Thrombocytopenia in Brucellosis With Eltrombopag

Background: Brucellosis is a common zoonotic illness in the world. Brucellosis is often characterized by hematologic abnormalities, including mild anemia, leukopenia, thrombocytopenia, or pancytopenia. However, severe refractory thrombocytopenia in brucellosis is very rare and easily misdiagnosed.Case presentation: The patient was a 5-year-old girl with brucellosis who developed severe refractory thrombocytopenia (platelet count: 3×109/L) with complaints of epistaxis, skin petechiae and purpura. Most conventional treatments including glucocorticoids and intravenous immunoglobulin (IVIg) did not elevate her platelets, but eltrombopag worked well and her platelet count recovered rapidly. One week later, the patient's symptoms improved and the platelet count returned to normal.Conclusions:Patients with severe refractory thrombocytopenia, particularly resistant to IVIg and steroid treatment should be considered for second-line drugs such as eltrombopag. Our results also increase the application experience of eltrombopag in Chinese patients with severe refractory thrombocytopenia in brucellosis. To the best of our knowledge, this case is the first reported case of the successful treatment of severe refractory thrombocytopenia in brucellosis with eltrombopag.