Avasthi R, Mohanty D, Chaudhary S C, Mishra Kiran
Department of Medicine, University College of Medical Sciences, (University of Delhi) and GTB Hospital, Delhi 95.
J Assoc Physicians India. 2010 Apr;58:243-4.
Disseminated tuberculosis can present in various ways including prolonged fever / pyrexia of unknown origin, hepatosplenomegaly, lymphadenopathy, meningitis and rarely extreme forms of hematological abnormalities such as pancytopenia and leukemoid reaction. We hereby report a case who presented with short history of fever, associated with vomiting and altered sensorium. He also had evidence of meningitis on neuroimaging with equivocal CSF finding. During his stay, he showed a spectrum of interesting hematological findings, including severe pancytopenia on peripheral smear, hemophagocytosis, epithelioid cell granuloma with Langhans' giant cells and focal necrosis consistent with tuberculosis on bone marrow examination. He showed an excellent clinical as well as hematological response to four drug antitubercular treatment (RHZE). The report highlights the significance of hematological picture in final confirmation of tuberculosis which may otherwise be passed off as nutritional or other unrelated causes.
播散性结核病可表现为多种形式，包括长期发热/不明原因发热、肝脾肿大、淋巴结病、脑膜炎，以及罕见的极端血液学异常形式，如全血细胞减少和类白血病反应。我们在此报告一例病例，该患者发热病史短，伴有呕吐和意识改变。神经影像学检查显示有脑膜炎证据，但脑脊液检查结果不明确。在其住院期间，他出现了一系列有趣的血液学检查结果，包括外周血涂片显示严重全血细胞减少、噬血细胞现象、骨髓检查发现有朗汉斯巨细胞的上皮样细胞肉芽肿和与结核病相符的局灶性坏死。他对四联抗结核治疗（RHZE）表现出良好的临床及血液学反应。该报告强调了血液学表现对最终确诊结核病的重要性，否则可能被误诊为营养性或其他无关原因。
