Yadav K Sushrith Kumar, Agrawal Aman Kumar, Biswal Seba Ranjan, Panda Pragnya, Panda Prateek Kumar, Sharawat Indar Kumar
Department of Pediatrics, Kalinga Institute of Medical Sciences, Bhubaneshwar, Odisha, India.
Department of Medicine, SCB Medical College, Cuttack, Odisha, India.
Adv Biomed Res. 2020 Dec 23;9:75. doi: 10.4103/abr.abr_170_20. eCollection 2020.
Extrapulmonary tuberculosis (TB) is a well-recognized cause of pyrexia of unknown origin. However, clinical presentation of TB in children with isolated hematological abnormalities is extremely rare. Anemia, usually normocytic, normochromic, leukopenia, leukocytosis, thrombocytopenia, thrombocytosis, and monocytosis are more common complications of TB rather than pancytopenia. Only anecdotal case reports and small case series are available in this regard. We are reporting an 18-year-old boy who presented with on and off low-grade fever for 3 months and anorexia and progressive pallor for 1 month. After extensive workup, pancytopenia remained unexplained. Bone marrow (BM) examination revealed caseating granulomas, along with Mantoux positivity and contact with sputum-positive pulmonary TB. He responded favorably to antitubercular therapy (ATT) within 2 months. This report alerts clinicians to be vigilant regarding the rare possibility of BM TB while investigating unexplained pancytopenia, as it is completely reversible with ATT.
肺外结核病是不明原因发热的一个公认病因。然而，孤立性血液学异常儿童的结核病临床表现极为罕见。贫血（通常为正细胞正色素性）、白细胞减少、白细胞增多、血小板减少、血小板增多和单核细胞增多是结核病较常见的并发症，而非全血细胞减少。关于这方面仅有零星的病例报告和小病例系列。我们报告一名18岁男孩，他持续低热3个月，伴有厌食，1个月来面色进行性苍白。经过广泛检查，全血细胞减少仍原因不明。骨髓检查发现干酪样肉芽肿，结核菌素试验阳性，且有与痰涂片阳性肺结核患者接触史。他在2个月内对抗结核治疗反应良好。本报告提醒临床医生，在调查不明原因的全血细胞减少时，要警惕骨髓结核这种罕见可能性，因为抗结核治疗可使其完全逆转。
