{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T07:15:10Z","timestamp":1783494910240,"version":"3.55.0"},"reference-count":9,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T00:00:00Z","timestamp":1783382400000},"content-version":"vor","delay-in-days":187,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Case Reports in Hematology"],"published-print":{"date-parts":[[2026,1]]},"abstract":"\n Introduction<\/jats:title>\n Acute lymphoblastic leukemia (ALL) is a rare hematologic malignancy that leads to significant qualitative and quantitative lymphocyte deficits. These immunological gaps predispose patients to various bacterial and opportunistic infections. Brucellosis, an intracellular infection endemic in many regions including Iran, presents with nonspecific symptoms such as prolonged fever, malaise, and organomegaly, which closely mimic the clinical manifestations of leukemia. Their co\u2010occurrence, even in brucellosis\u2010endemic areas, is actually rare. In addition, their similarity in clinical presentation can result in diagnostic delay or misdiagnosis.<\/jats:p>\n <\/jats:sec>\n \n Case Presentation<\/jats:title>\n \n A 47\u2010year\u2010old male shepherd from an endemic region in Iran presented with a 1\u2010month history of progressive weight loss, fever (38.4\u00b0C), and muscle cramps. Initial physical examination revealed pallor and tachycardia without lymphadenopathy. Laboratory investigations showed severe leukocytosis (103\u2009\u00d7\u200910\n 3<\/jats:sup>\n \/\u03bcL) and elevated lactate dehydrogenase (1190 U\/L). Although initial serological tests for brucellosis (Wright and 2\u2010ME) were negative, bone marrow aspiration and flow cytometry confirmed B\u2010cell ALL. Cytogenetic analysis identified the Philadelphia chromosome (\n t<\/jats:italic>\n (9; 22), p210 transcript). The patient began induction chemotherapy with the hyper\u2010CVAD regimen combined with dasatinib. Despite hematological improvement, persistent fever and diaphoresis prompted a re\u2010evaluation for infectious etiologies. Repeated brucellosis testing yielded strongly positive results (Wright 1\/320 and 2\u2010ME 1\/640), suggesting a potential prozone effect in initial tests or recent acquisition. Antibiotic therapy with rifampin and doxycycline was integrated into the oncological protocol. The patient showed rapid clinical improvement within 1\u2009week and subsequently achieved complete remission, which was maintained throughout a 2\u2010year follow\u2010up.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n This case highlights the importance of considering brucellosis in the differential diagnosis of febrile patients with hematologic malignancies in endemic areas. Overlapping symptoms can lead to diagnostic delays. It is crucial to repeat serological tests or use serial dilutions to circumvent the prozone effect when clinical suspicion persists in immunocompromised patients.<\/jats:p>\n <\/jats:sec>","DOI":"10.1155\/crh\/1752123","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T06:42:35Z","timestamp":1783492955000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Concurrent Brucellosis and Acute Lymphoblastic Leukemia: A Case Report"],"prefix":"10.1155","volume":"2026","author":[{"given":"Parisa","family":"Bahramian","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7987-463X","authenticated-orcid":false,"given":"Marziyeh","family":"Ghalamkari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahdi","family":"Khatuni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saeed","family":"Kalantari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Behnaz","family":"Varaminian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,7]]},"reference":[{"key":"e_1_2_10_1_2","article-title":"About Acute Lymphocytic Leukemia (ALL)","author":"American Cancer Society","year":"2018","journal-title":"Cancer.Org"},{"key":"e_1_2_10_2_2","doi-asserted-by":"publisher","DOI":"10.3349\/ymj.2006.47.5.741"},{"key":"e_1_2_10_3_2","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2021.737340"},{"key":"e_1_2_10_4_2","volume-title":"Brucellosis: Epidemiology, Microbiology, Clinical Manifestations and Diagnosis","author":"Bosilkovski M.","year":"2023"},{"key":"e_1_2_10_5_2","first-page":"1819","article-title":"MicroRNAs as Modulators of the Immune Response in T-Cell Acute Lymphoblastic Leukemia","volume":"23","author":"Gaizo M.","year":"2022","journal-title":"International Journal of Molecular Sciences"},{"key":"e_1_2_10_6_2","doi-asserted-by":"publisher","DOI":"10.4103\/0974-2727.72149"},{"key":"e_1_2_10_7_2","doi-asserted-by":"crossref","DOI":"10.3389\/fvets.2022.976215","article-title":"Prevalence, Diagnosis, and Manifestations of Brucellosis: A Systematic Review and Meta-Analysis","volume":"9","author":"Khoshnood S.","year":"2022","journal-title":"Frontiers in Veterinary Science"},{"key":"e_1_2_10_8_2","first-page":"1819","article-title":"Chronic Brucellosis and Hodgkin\u2019s Disease","volume":"21","author":"Stempien R.","year":"1968","journal-title":"Wiadomosci Lekarskie"},{"key":"e_1_2_10_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cvfa.2022.02.003"}],"container-title":["Case Reports in Hematology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/crh\/1752123","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1155\/crh\/1752123","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/crh\/1752123","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T06:42:37Z","timestamp":1783492957000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1155\/crh\/1752123"}},"subtitle":[],"editor":[{"given":"Kalyani","family":"Sen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":9,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1155\/crh\/1752123"],"URL":"https:\/\/doi.org\/10.1155\/crh\/1752123","archive":["Portico"],"relation":{},"ISSN":["2090-6560","2090-6579"],"issn-type":[{"value":"2090-6560","type":"print"},{"value":"2090-6579","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2025-09-15","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-20","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-07","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"1752123"}}