Kumar Perikala Vijayananda, Monabati Ahmad, Kadivar Rahim, Soleimanpour Hossein
Department of Pathology, Shiraz Medical School, Shiraz, Iran.
J Pediatr Hematol Oncol. 2005 Feb;27(2):97-9. doi: 10.1097/01.mph.0000153957.95486.8b.
The authors describe an unusual case of a disseminated bacille Calmette-Guerin (BCG) infection in a 3-month-old girl who presented with a huge hepatosplenomegaly, fever, and pancytopenia. Clinically, an infantile kala-azar or lymphoma/leukemia was suspected. However, after thorough clinical and paraclinical investigations, the case was diagnosed as a disseminated BCG infection. The child died 2 weeks after starting antituberculosis treatment. Autopsy revealed diffuse histiocytic infiltration in the liver, spleen, and mesenteric lymph nodes, which were loaded with acid-fast bacilli. Three interesting findings were noticed in this case: circulating monocytes in the peripheral blood were loaded with ghost acid-fast bacilli; bone marrow smears revealed numerous Gaucher cell-like macrophages loaded with negative images of Mycobacterium tuberculi; and there was extensive marrow necrosis. These findings have not been previously reported in the literature.
作者描述了一例不同寻常的播散性卡介苗（BCG）感染病例，患儿为一名3个月大的女孩，表现为巨大肝脾肿大、发热和全血细胞减少。临床上，怀疑为婴儿型黑热病或淋巴瘤/白血病。然而，经过全面的临床和辅助检查后，该病例被诊断为播散性BCG感染。患儿在开始抗结核治疗2周后死亡。尸检显示肝脏、脾脏和肠系膜淋巴结有弥漫性组织细胞浸润，其中充满抗酸杆菌。该病例有三个有趣的发现：外周血中的循环单核细胞充满了空壳抗酸杆菌；骨髓涂片显示大量类似戈谢细胞的巨噬细胞，其中充满结核分枝杆菌的阴性影像；并且存在广泛的骨髓坏死。这些发现此前尚未见文献报道。
