Pancytopenia without hepatosplenomegaly: A rare manifestation of extrapulmonary tuberculosis in an adolescent boy

Yadav, K Sushrith Kumar; Agrawal, Aman Kumar; Biswal, Seba Ranjan; Panda, Pragnya; Panda, Prateek Kumar; Sharawat, Indar Kumar

Pancytopenia without hepatosplenomegaly: A rare manifestation of extrapulmonary tuberculosis in an adolescent boy

Document Type : CASE REPORT

Authors

¹ Department of Pediatrics, Kalinga Institute of Medical Sciences, Bhubaneshwar, Odisha, India

² Department of Medicine, SCB Medical College, Cuttack, Odisha, India

³ Department of Pediatrics, Pediatric Neurology Division, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

Abstract

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.

Keywords

References

1.	Avasthi R, Mohanty D, Chaudhary SC, Mishra K. Disseminated tuberculosis: Interesting hematological observations. J Assoc Physicians India 2010;58:243-4.
2.	Kaba Ö, Kara M, Odacılar CA, Kamer İ, Sütçü M, Demir SÖ, et al. Evaluation of cases of pediatric extrapulmonary tuberculosis: A single center experience. Turk Pediatri Ars 2019;54:86-92.
3.	Le Hô H, Barbarot N, Desrues B. Pancytopenia in disseminated tuberculosis: Think of macrophage activation syndrome. Rev Mal Respir 2010;27:257-60.
4.	Feng J, Zhang H, Zhong DR. A clinical analysis of 20 cases with bone marrow granulomas. Zhonghua Nei Ke Za Zhi 2009;48:485-7.
5.	Bhargava V, Farhi DC. Bone marrow granulomas: Clinicopathologic findings in 72 cases and review of the literature. Hematol Pathol 1988;2:43-50.
6.	Alghamdi AA, Awan FS, Maniyar IH, Alghamdi NA. Unusual manifestation of extrapulmonary tuberculosis. Case Rep Med 2013;2013:353798.
7.	Dalugama C, Gawarammana IB. Fever with pancytopenia: Unusual presentation of extrapulmonary tuberculosis: a case report. J Med Case Rep 2018;12:58.
8.	Hakawi AM, Alrajhi AA. Tuberculosis of the bone marrow: Clinico-pathological study of 22 cases from Saudi Arabia. Int J Tuberc Lung Dis 2006;10:1041-4.
9.	Yadav TP, Mishra S, Sachdeva KJ, Gupta VK, Siddhu KK, Bakshi G, et al. Pancytopenia in disseminated tuberculosis. Indian Pediatr 1996;33:597-9.

Advanced Biomedical Research