A 39-year-old female presented with a one month history of weakness, headache, nausea, vomiting and fever. A physical examination revealed significant pallor, fever (axillary's measurement: 39℃) and tachycardia (pulse rate: 100/min). A high erythrocyte sedimentation rate (120 mm/hr), pancytopenia in complete blood count (Hb: 6.0 g/dL, platelet: 34 × 10⁹/L, WBC: 1.1 × 10⁹/L with 80% lymphocyte, 10% atypical mononuclear cells, 10% neutrophil) was detected in a laboratory examination. The serum biochemistry parameters were within normal ranges; BUN: 24 mg/dL, creatinine: 1.2 mg/dL, urate: 6.6 mg/dL, alanine transaminase: 22 U/L, aspartate transaminase: 31 U/L and lactic dehydrogenase: 185 U/L. Bone marrow aspiration and trephine biopsy histologically consisted of ALL (90% of the nucleated cells of bone marrow were lymphoblasts which were T cell immuno-histochemical markers) (Fig. 1, 2). A chemotherapy regimen, consisting of adriamycine (50 mg/week/total two doses), vincristine (2 mg/week/total two doses) and prednisone (100 mg/day/p.o./for 14 days), was started. Brucella melitensis was detected in a bone marrow culture, so a brucellosis treatment (streptomycin 1 g/day/intramuscularly, doxycycline 100 mg/bid/p.o.) was added. Her temperature returned to normal within three weeks, and the complete blood count and bone marrow findings also returned to normal (Hb: 12 g/dL, platelet: 180 × 10⁹/L, WBC: 4.5 × 10⁹/L, with 70% neutrophil, 25% lymphocyte and 5% monocyte, a bone marrow aspirate was normocellular and the blasts content was less than 1% of the nucleated cells). The patient received brucellosis treatment for six weeks. Repeat blood and bone marrow cultures and an agglutination test were negative. The patient is in complete remission from ALL, and the follow up continuing.

A 40-year-old female presented with a 20 day history of fever, weakness, headache and weight loss and a one week history of jaundice. On admission she was febrile (axillary's measurement: 38.5℃), pancytopenic (Hb: 7g/dL, platelet: 20 × 10⁹/L, WBC: 0.5 × 10⁹/L, with 90% lymphocyte and 10% neutrophil) and demonstrated acute hepatitis (AST: 250 U/L, ALT: 320 U/L, direct bilirubin: 12 mg/dL, indirect bilirubin: 8 mg/dL, LDH: 450 U/L). A bone marrow aspiration histologically consisted of ALL (90% of the nucleated cells of bone marrow were lymphoblasts, which were T cell immuno-histochemical stained). The blood and bone marrow cultures were positive for Brucella melitensis. Because the liver function tests were abnormal, i.v. ciprofloxacin was started at 100 mg twice a day. In addition to this treatment prednisone (100 mg/day/p.o.) and vincristine (2 mg/day/once in a week for three doses) were used for ALL. Her temperature was normal on the 14th day, and the clinical and laboratory findings were nearly normal (Hb: 11 g/dL, platelet count: 90 × 10⁹/L, WBC: 3.2 × 10⁹/L, with 75% neutrophil, 23% lymphocyte, 2% monocyte, AST: 72 U/L, ALT: 83 U/L, direct bilirubin: 2.1 mg/dL, indirect bilirubin: 1.2 mg/dL, LDH: 450 U/L). The leukemic infiltration disappeared in a bone marrow biopsy (blasts < 1%) and a liver biopsy revealed findings of granulomatous hepatitis (Fig. 3). Twenty days later she presented again with fever, jaundice and pancytopenia. A bone marrow biopsy showed 90% lymphoblasts. The blood and bone marrow cultures were negative for brucella, and a brucella agglutination test was negative. The ALL Hoelzer remission induction protocol was administered to the patient, and complete remission obtained. Two months later, a relapse occurred during the administration of consolidation treatment. Although re-induction treatment was given, she died due to resistant leukemia.