THE CHALLENGES OF TREATMENT OF PATIENT WITH VIRAL HEPATITIS C AND BRUCELLOSIS

Brucellosis is a widespread zoonotic illness with significant morbidity rates in Armenia. It causes a wide range of clinical consequences as it progresses, from mild ones that don't require changing the composition or length of an antibiotic prescription to fortunately uncommon, fatal situations involving the heart or central nervous system. According to the National Institutes of Health's Annual Statistical Records, the number of cases with Brucellosis that were initially diagnosed in Armenia was 309 in 2015, 362 in 2017, and 201 in 2018; simultaneously no data for 2016 has been provided. As Brucellosis is an endemic disease for Armenia, sometimes there can be co-infection of Brucellosis with other diseases. Management of such cases is difficult because of drug-drug interactions and hepato toxicity of drags. The aim of the case report is to discuss the challenges of management of patient with Brucellosis and Viral Hepatitis C infection. A 59-year-old man was admitted to the hospital, Intensive Care Unit with gastrointestinal bleeding with a primary diagnosis of liver encephalopathy. Based on the clinical and laboratory findings, the patient was diagnosed with liver cirrhosis of mixed etiology (alcohol + Viral Hepatitis C), Child-Pugh C class (decompensated disease) Meld-Na22, splenomegaly, grade 3 ascites, stage 3 liver encephalopathy. 2 months after the first hospitalization the patient started to develop an increase in body temperature (up to 39C), pain in the spine, neuropathies and paresthesia. Patient was tested for Brucellosis, Wright-Hedelson (agglutination test) positive results (positive, 1:200 respectively), and positive serology results (high levels of IgG and IgM) confirmed diagnosis. Patient was treated based on international guidelines and drug-drug interaction information.