Title : A rare presentation of disseminated tuberculosis with involvement of bone marrow
Abstract:
INTRODUCTION:
Tuberculosis of Bone marrow incidence reported range from 0.3 to 3%TB. Bone marrow Tuberculosis is a form of hematogenously disseminated tuberculosis with nonspecific manifestations. Therefore, in early stage of presentation ,bone marrow aspiration and bone marrow biopsy with histopathological and microbiological examination may facilitate confirmation of the diagnosis.
CASE REPORT:
42-Year-old Asian male presented with complaints of productive cough, low grade fever ,loss of appetite and weight loss, with grade 1 MMRC breathlessness for 5months with h/o massive hemoptysis for 1day. Patient had past history of treated and cured pulmonary tuberculosis at 2015. He is known case of type 2 Diabetes mellitus on insulin for past 1 year since 2020. Patient being evaluated in local health care center with baseline blood parameters within normal range and found to be sputum positive for AFB bacilli with CT chest suggestive of left upper lobe apicoposterior and lingular cavitary consolidation with centrilobular nodules and labelled as microbiologically confirmed pulmonary tuberculosis on ATT FDC for last 1month.
Inspite of antituberculosis therapy , patient had complainits of persistent cough and h/o hemoptysis, severe fatigability. On evaluation anemia(hb-7.5) and severe thrombocytopenia(platelet -1000 cells/ul, total WBC count 4220, peripheral smear-microcytic hypochromic anemia with thrombocytopenia. Bone marrow aspiration and biopsy suggestive of marrow hypoplasia with granulomatous infiltration of bone marrow with caseous necrosis with impression of bone marrow tuberculosis. Bonemarrow aspirate genexpert detected mycobacterium tuberculosis low with rifampicin sensitive. Patient is diagnosed as bone marrow tuberculosis with rifampicin induced thrombocytopenia,patient started on modified ATT regimen (Isoniazid, Ethambutol, Pyrazinamide and Streptomycin) after individual drug challenge. Patient condition improved and responding well to treatment and on regular follow up.
DISCUSSION :
When a tuberculosis patient presented with complaints of severe fatigueness, weight loss , hemoptysis pancytopenia/ anemia/ thrombocytopeni /leucopenia , peripheral smear should be done and other causes of pancytopenia / coexistant malignancy causes tobe ruled out. Bone marrow aspiration and biopsy tobe done histopathological and microbiological confirmation tobe done for tuberculosis dissemination into bone marrow. Being rare incidence bonemarrow tuberculosis shoulnot be missed out as it has high rate of mobidity and mortality rate and treatment with antitubercular theraphy should be initiated as early as possible for better prognosis and outcome.
Bone marrow changes in tuberculosis are myeloid hyperplasia; plasmocytosis; megaloblastoid maturation; aplasia/hypoplasia; haemophagocytosis; caseating and non caseating granulomas ,bonemarrow necrosis;myelofibrosis.
