To explore the clinical characteristics, treatment and prognosis of patients with acquired aplastic anemia (AA) secondary to brucellosis in pregnancy.

A case of patient with brucellosis in full-term pregnancy leading to secondary acquired AA (patient 1) admitted to the Second Affiliated Hospital of Dalian Medical University in February 2020 was selected as the study subject. A retrospective analysis method was employed to analyze her clinical data. Using " pregnancy" " brucellosis" " acquired aplastic anemia" as Chinese and English keywords, the search results of relevant literature on acquired AA secondary to brucellosis in pregnancy in CNKI database, Wanfang Data Knowledge Service Platform and PubMed database showed that there were no relevant reports on acquired AA secondary to brucellosis in pregnancy. Therefore, " pregnancy" " brucellosis" and " case report" were used as Chinese and English keywords to search the above databases. The literature retrieval time was set from the establishment of each database to March 2026. The clinical data of patients with brucellosis in pregnancy reported at home and abroad were comprehensively analyzed. The procedures followed in this study was complied with the requirements of the Helsinki Declaration of the World Medical Association revised in 2013.

① Patient 1 was a 33-year-old female, who was treated in our hospital due to " 37^{+ 2} weeks of amenorrhea and a small amount of vaginal bloody secretions for 1 day". Patient 1 had lived in a brucellosis-endemic area for a long time and had a history of contact with cattle and sheep. She was treated for fever and fatigue 10 years ago, and blood culture and bone marrow examination indicated brucellosis infection. Serological examination before and during this pregnancy indicated positive Brucella antibody. During this pregnancy, she experienced fatigue, profuse sweating, nausea, joint pain and skin ecchymosis, and gradually developed severe cytopenia. The platelet count (PLT) during pregnancy was (5-20)×10⁹/L (abnormally lower than the normal reference value), and the hemoglobin (Hb) level was 52-70 g/L (abnormally lower than the normal reference value). She received intermittent platelet and red blood cell transfusions, with transient effects. After treatment with rifampicin, the PLT transiently increased to 100×10⁹/L, but the full course of treatment was not completed due to gastrointestinal adverse reactions. Laboratory examination after this admission showed white blood cell count (WBC) was 4.05×10⁹/L, PLT was 5×10⁹/L, Hb was 52 g/L, and positive Brucella immunoglobulin (Ig)G antibody. After multidisciplinary team consultation, she was treated with intravenous immunoglobulin (20 g/d) and dexamethasone (6 mg/12 h), along with supportive treatment of 2 U platelets and 4 U red blood cells. After the PLT rose to 59×10⁹/L and Hb rose to 58 g/L, an emergency cesarean section was performed under subarachnoid block anesthesia. The newborn was in good condition at birth, with an Apgar score of 10 points at 1 minute after birth, a birth weight of 2 750 g, a normal umbilical cord blood complete blood cell count, and positive umbilical cord blood Brucella IgG antibody. Placental pathological examination showed congestion of placental villous capillaries, small focal infarction and a small amount of inflammatory cell infiltration. The PLT of patient 1 decreased again after cesarean section. After further hematological evaluation, bone marrow examination was rechecked at the Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences. Combined with the bone marrow examination results, clinical manifestations and exclusion of other secondary factors, she was diagnosed as acquired AA secondary to brucellosis. And after treatment with recombinant erythropoietin, immunosuppressants and glucocorticoids, the above parameters improved, and she was discharged. Follow-up results at 42 days and 6 months postoperatively for patient 1 showed that the PLT remained at approximately 20×10⁹/L, with no obvious bleeding manifestations. ② According to the literature search strategy set in this study, a total of 6 articles related to patients with brucellosis in pregnancy were retrieved, involving 6 patients with brucellosis in pregnancy (patients 2-7). Together with patient 1, a total of 7 patients were included for comprehensive analysis. The average age of these 7 patients was 28 years, including 5 primiparas and 2 multiparas. The main clinical manifestations were joint pain (5 cases), fatigue (4 cases), hyperhidrosis (3 cases), and fever (2 cases). One case underwent misoprostol induction at 6⁺ months of gestation, and 6 cases delivered live newborns, including 4 cases of premature delivery and 2 cases of full-term delivery.

Acquired AA secondary to brucellosis in pregnancy is extremely rare, and its pathogenesis is complex. Brucellosis in pregnancy can pose a serious threat to both the pregnant mother and the fetus, and early diagnosis and timely intervention are crucial. For the treatment of brucellosis in pregnancy, multidisciplinary team collaboration is required, and comprehensive consideration of anti-infection, supportive treatment and hematological management is needed to reduce the risk of secondary AA.