Dalugama Chamara, Gawarammana Indika Bandara
Department of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
J Med Case Rep. 2018 Mar 6;12(1):58. doi: 10.1186/s13256-018-1596-0.
Tuberculosis is a major health problem in the developing world. Diagnosis of extrapulmonary tuberculosis is delayed because the presentation is nonspecific. Extrapulmonary tuberculosis can present with various hematological manifestations, including pancytopenia. Pancytopenia could be due to hypersplenism, maturation arrest, hemophagocytic lymphohistiocytosis, or infiltration of the bone marrow by caseating or noncaseating granulomas causing reversible or irreversible fibrosis.
We report a case of a 56-year-old Sri Lankan Sinhalese man who presented with pyrexia of known origin with significant loss of weight and loss of appetite. He had mild pallor with mild hepatosplenomegaly. He had high inflammatory markers with pancytopenia in a peripheral blood smear. His chest radiograph was unremarkable, and he had a negative Mantoux test result. A diagnosis of disseminated tuberculosis was made on the basis of caseating tuberculous granulomas in the bone marrow.
Disseminated tuberculosis remains a diagnostic challenge because the presentation is vague and nonspecific. In case of pyrexia of unknown origin with peripheral cytopenia, the possibility of disseminated tuberculosis should be considered, particularly in endemic areas. Simultaneous culture and histopathological examination of the bone marrow is important in such instances, because results of common tests such as chest radiography or Mantoux tests can be negative.
结核病是发展中国家的一个主要健康问题。肺外结核的诊断往往会延迟，因为其临床表现不具有特异性。肺外结核可表现出各种血液学表现，包括全血细胞减少。全血细胞减少可能是由于脾功能亢进、成熟停滞、噬血细胞性淋巴组织细胞增生症，或干酪样或非干酪样肉芽肿浸润骨髓导致可逆或不可逆纤维化所致。
我们报告一例56岁的斯里兰卡僧伽罗族男性患者，该患者因已知病因发热，伴有明显体重减轻和食欲不振。他有轻度面色苍白，伴轻度肝脾肿大。他的炎症指标较高，外周血涂片显示全血细胞减少。他的胸部X光片无明显异常，结核菌素试验结果为阴性。根据骨髓中干酪样结核肉芽肿确诊为播散性结核病。
播散性结核病仍然是一个诊断难题，因为其表现模糊且不具有特异性。对于不明原因发热伴外周血细胞减少的病例，应考虑播散性结核病的可能性，尤其是在流行地区。在这种情况下，同时进行骨髓培养和组织病理学检查很重要，因为胸部X光片或结核菌素试验等常规检查结果可能为阴性。
