Mehrdad Payandeh¹, Edris Sadeghi^{2, 3,}, Masoud Sadeghi^{2, 3}, Fariba Falsafi⁴

Introduction: Colorectal cancer is the fourth most common cancer in men and the third most common in women. Brucella infections in immune compromised hosts (like CLL) are relatively rare. Herein, we reported first case report, a patient have been diagnosed as simultaneous CLL and brucellosis during his follow up that she indicated a subsequent neoplasm after CLL according to our knowledge. Case Report: A 77-year-old male, presented to his primary care provider with complaint of weakness and fatigue. After analysis with bone marrow aspiration and biopsy, there was heavy infiltration with well-differentiated small lymphocytes so we diagnosed CLL for her problems. Then he was treated with prednisolone and cyclophosphamide with allopurinol. During the treatment period (about one year after the first visit), the patient was suffering from brucellosis that treated with cotrimoxazole + rifampicin regimen. In the continued his treatment, he had been treated with danazol and then intravenous immunoglobulin for a few attack of severe pneumonia. Recently he suffer of complaint of hematochezia, then refer for rectosigmoidoscopy with rectal mass lesion. In pathology reported well differentiation rectum adenocarcinoma. He had chemo irradiation with capecitabine and then with adjuvant regimen of CAPOX (Xeloda with oxaliplatin). At now he is alive with classic follow up. Conclusion: In patients with CLL and brucellosis we suggest that treatment for infection and leukemia simultaneously and we have enough notice about the patient's conditions because it may be created second non hematological malignancy. These clinical procedures make life more for the patient.

Brucellosis, CLL, Hematochezia, Rectal cancer