1
|
Ju B, Xiu NN, Xu J, Yang XD, Sun XY, Zhao XC. Flared inflammatory episode transforms advanced myelodysplastic syndrome into aplastic pancytopenia: A case report and literature review. World J Clin Cases 2023; 11:4105-4116. [PMID: 37388797 PMCID: PMC10303598 DOI: 10.12998/wjcc.v11.i17.4105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/21/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Myelodysplastic syndrome (MDS) is a hematological neoplasm, and an increase in myeloblasts is representative of leukemic hematopoiesis in advanced MDS. Low-risk MDS usually exhibits deranged autoimmunity resembling that of aplastic anemia (AA), whereas advanced MDS is characterized by a phenotype of immune exhaustion. MDS can be normo/hyperplastic or hypoplastic. Generally, bone marrow cellularity and myeloblasts increase with disease progression. Transformation from advanced MDS to AA-like syndrome with leukemic cell regression has not previously been reported.
CASE SUMMARY A middle-aged Chinese woman had a 4-year history of leukocytopenia. Six months prior to admission, the patient developed gradually worsening fatigue and performance status. The leukocytopenia further progressed. She was diagnosed with MDS with excess blasts-2 based on increased bone marrow cellularity and an increased percentage of myeloblasts on marrow and blood smears, an increased percentage of cluster of differentiation (CD)34+CD33+ progenitors in immunotyping analysis, a normal karyotype in cytogenetic analysis, and the identification of somatic mutations in CBL, KMT2D and NF1 in molecular analysis. Initially, neutropenia was the predominant hematological abnormality, with mild anemia and thrombocytosis, and the degree of fatigue was far more severe than the degree of anemia. In the following months, the patient experienced several febrile episodes. Intravenous antibiotic treatments were able to control the febrile episodes, but the elevated inflammatory indices persisted. The hematological parameters dramatically fluctuated with the waxing and waning of the inflammatory episodes. With recurrent flares of the inflammatory condition, agranulocytosis and severe anemia developed, with mild thrombocytopenia. During the patient’s hospitalization, computed tomography (CT) scans revealed the presence of extensive inflammatory lesions involving the lungs, mediastinum, pleura, gastrointestinal tract, peritoneum and urinary tract, with imaging features suggestive of the reactivation of disseminated tuberculosis. Reevaluation of the bone marrow smears revealed that the cellularity became hypoplastic, and the leukemic cells regressed, suggesting that both normal and leukemic hematopoiesis had been heavily suppressed. Immunological analysis of the bone marrow samples revealed a decreased percentage of CD34+ cells and an immunological signature resembling that of severe AA (SAA), confirming the regression of the leukemic cells by autoimmune-mediated attacks. The patient demonstrated resistance to multiple drugs, including antituberculotics, recombinant human granulocyte colony-stimulating factor, broad-spectrum antibiotics, voriconazole, ganciclovir, immune suppressants, eltrombopag and intravenous immunoglobulin, which further worsened the hematological injury and patient’s performance status. The patient eventually died of overwhelming infection and multidrug resistance.
CONCLUSION Advanced MDS can transform to aplastic cytopenia with leukemic cell regression and an immunological signature of SAA during inflammatory flare-ups.
Collapse
Affiliation(s)
- Bo Ju
- Department of Hematology, The Central Hospital of Qingdao West Coast New Area, Qingdao 266555, Shandong Province, China
| | - Nuan-Nuan Xiu
- Department of Hematology, The Central Hospital of Qingdao West Coast New Area, Qingdao 266555, Shandong Province, China
| | - Jia Xu
- Department of Hematology, The Central Hospital of Qingdao West Coast New Area, Qingdao 266555, Shandong Province, China
| | - Xiao-Dong Yang
- Department of Hematology, The Central Hospital of Qingdao West Coast New Area, Qingdao 266555, Shandong Province, China
| | - Xiao-Yun Sun
- Department of Hematology, The Central Hospital of Qingdao West Coast New Area, Qingdao 266555, Shandong Province, China
| | - Xi-Chen Zhao
- Department of Hematology, The Central Hospital of Qingdao West Coast New Area, Qingdao 266555, Shandong Province, China
| |
Collapse
|
2
|
Alebbi SM, Kambal A, Abo Samra H, Sharaf Eldean MZ, Mohamed SF, Al-Shokri SD. Case Report: Tuberculosis-Induced Autoimmune Hemolytic Anemia. Am J Trop Med Hyg 2023; 108:313-316. [PMID: 36535253 PMCID: PMC9896313 DOI: 10.4269/ajtmh.22-0217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 09/01/2022] [Indexed: 12/23/2022] Open
Abstract
Tuberculosis (TB) is an infectious disease that affects different organs, causing multiple complications, including hematological sequelae. One of the most common TB-hematological complications is anemia of chronic disease. Very rarely autoimmune hemolytic anemia (AIHA) has been reported as an uncommon manifestation of TB. In this case, we present a female who presented with refractory AIHA, which was attributed to disseminated TB. The patient responded well to steroids, anti-TB medications, and rituximab.
Collapse
Affiliation(s)
- Seham M. Alebbi
- Department of Medical Education, Hamad Medical Corporation, Doha, Qatar
| | - Aalaa Kambal
- Clinical Imaging Department, Hamad Medical Corporation, Doha, Qatar
| | - Hayan Abo Samra
- Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar
- Histopathology Department, Hamad Medical Corporation, Doha, Qatar
| | - Mouhammad Z. Sharaf Eldean
- Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar
- Histopathology Department, Hamad Medical Corporation, Doha, Qatar
| | - Shehab Fareed Mohamed
- Department of Hematology and Medical Oncology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - Shaikha D. Al-Shokri
- Department of Medical Education, Hamad Medical Corporation, Doha, Qatar
- Department of Internal Medicine, Case Western Reserve University–MetroHealth Medical Center, Cleveland, Ohio
| |
Collapse
|
3
|
Venkitakrishnan R, Augustine J, Paul M, Abraham L. Disseminated tuberculosis associated with autoimmune haemolytic anaemia and adrenal deficiency: a rare association. BMJ Case Rep 2022; 15:e249277. [PMID: 35246442 PMCID: PMC8900022 DOI: 10.1136/bcr-2022-249277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 11/04/2022] Open
Abstract
Tuberculosis (TB) is one of the greatest masqueraders in medical practice and can have manifestations involving any organ or organ systems of the body. The presentation of disseminated TB can range from typical features like fever, weight loss and fatigue to protean manifestations. We share the case of an elderly man who presented to us with weight loss, anaemia, weakness and lymphadenopathy involving thoracic and intraabdominal locations. Work up of anaemia revealed features of Coombs-positive autoimmune haemolytic anaemia (AIHA) and evaluation of weakness showed laboratory results consistent with adrenal insufficiency. Biopsy of the abdominal lymphnode yielded caseating granulomas with CB-NAAT positivity for Mycobacterium tuberculosis Anti-TB chemotherapy with short-term replacement dose of systemic steroids corrected the haemolysis, anaemia and addisonian crisis. The case alerts clinicians regarding the uncommon association of TB with Coombs positive AIHA and adds one more aetiology to the pathogenesis of anaemia in TB. Furthermore, the occurrence of AIHA and hypoadrenalism in the same patient with TB is exceedingly rare and has not been reported.
Collapse
Affiliation(s)
| | | | - Mobin Paul
- Clinical Hematology, Rajagiri Hospital, Aluva, India
| | - Latha Abraham
- Department of Pathology, Rajagiri Hospital, Aluva, Kerala, India
| |
Collapse
|
4
|
Rathish D, Siribaddana S. Tuberculosis induced autoimmune haemolytic anaemia: a systematic review to find out common clinical presentations, investigation findings and the treatment options. Allergy Asthma Clin Immunol 2018; 14:11. [PMID: 29599802 PMCID: PMC5868065 DOI: 10.1186/s13223-018-0236-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 02/06/2018] [Indexed: 12/03/2022] Open
Abstract
Background Tuberculosis induced autoimmune haemolytic anaemia is a rare entity. The aim of this study was to explore its common presentations, investigation findings and treatment options through a systematic review of published reports. Methods PubMed, Trip, Google Scholar, Science Direct, Cochrane Library, Open-Grey, Grey literature report and the reference lists of the selected articles were searched for case reports in English on tuberculosis induced auto-immune haemolytic anaemia. PRISMA statement was used for systematic review. Quality assessment of the selected reports was done using the CARE guidelines. Results Twenty-one articles out of 135 search results were included. Thirty-three percent of patients were reported from India. More than half had fever and pallor. The mean haemoglobin was 5.77 g/dl (SD 2.2). Positive direct coombs test was seen in all patients. Pulmonary tuberculosis (43%) was most prevalent. Twenty-nine percent of patients needed a combination of anti-tuberculosis medicines, blood transfusion and steroids. Higher percentage of disseminated TB induced AIHA (67%) needed steroids in comparison to the other types of TB induced AIHA (13%). Conclusions Rarer complications of tuberculosis such as auto-immune haemolytic anaemia should be looked for especially in disease-endemic areas. Blood transfusion and steroids are additional treatment options along with the anti-tuberculosis medicines. Electronic supplementary material The online version of this article (10.1186/s13223-018-0236-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Devarajan Rathish
- 1Department of Pharmacology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, 50008 Sri Lanka
| | - Sisira Siribaddana
- 2Department of Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, 50008 Sri Lanka
| |
Collapse
|
5
|
Abstract
Tuberculosis (TB) affects the production and life span of all hematologic cellular components. In addition, plasma coagulation factors may be affected, resulting in sometimes life-threatening complications. Iron, folate, and vitamin B12 metabolism is derailed. The pharmacological agents used for TB therapy may also cause hematologic changes. There are some uncommon manifestations of TB in nontuberculous hematologic patients. There have been some exciting developments in the field of imaging to screen for TB, TB pathophysiology at the cellular level, and our understanding of immune response in TB. Advances have been made in pharmacologic therapeutic options, including discovery of new drugs in the fight against drug-resistant TB, bearing in mind their hematologic effects. This chapter reviews and updates known hematologic effects of TB and its therapy and some lesser known effects of TB in patients with nontuberculous hematologic conditions.
Collapse
|
6
|
Yi N, Jung BG, Wang X, Vankayalapati R, Samten B. The early secreted antigenic target of 6 kD of Mycobacterium tuberculosis inhibits the proliferation and differentiation of human peripheral blood CD34 + cells. Tuberculosis (Edinb) 2016; 101S:S28-S34. [PMID: 27745787 DOI: 10.1016/j.tube.2016.09.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Abnormalities in hematopoiesis are common in tuberculosis patients and highly prevalent in AIDS patients with tuberculosis coinfection. To explore the potential role of the early secreted antigenic target of 6-kD (ESAT-6) of Mycobacterium tuberculosis (Mtb) in abnormal hematopoiesis in tuberculosis, we studied the effect of ESAT-6 on proliferation and differentiation of in vitro-expanded CD34+ cells isolated from the peripheral blood of the healthy donors. ESAT-6 but not control protein antigen 85A (Ag85A) of Mtb inhibited the proliferation of CD34+ cell derived peripheral blood stem/progenitor cells (PBSPC) in a dose dependent manner when determined by MTT-assay. ESAT-6 but not Ag85A reduced the number of colony forming cells (CFC) of PBSPC by 60-90% as determined by CFC assay by incubation of CD34+ cells in a semi-solid cellulose media in the presence of cytokine cocktail for two weeks. ESAT-6 but not Ag85A increased the percentages of the Annexin-V positive cells and enhanced the cleavage of caspase-3 in PBSPC in a time and dose dependent manner as determined by flow cytometry and Western blot analysis, respectively. ESAT-6 also inhibited murine bone marrow derived non-adherent cell proliferation in response to granulocyte-macrophage colony stimulating factor treatment. We conclude that ESAT-6, an essential virulence factor of Mtb, may contribute to the abnormal hematopoiesis of tuberculosis patients by inhibiting the proliferation and differentiation of hematopoietic cells via apoptosis.
Collapse
Affiliation(s)
- Na Yi
- The Department of Pulmonary Immunology, University of Texas Health Science Center at Tyler, 11937 US HWY 271, Tyler, TX 75708-3154, USA
| | - Bock-Gie Jung
- The Department of Pulmonary Immunology, University of Texas Health Science Center at Tyler, 11937 US HWY 271, Tyler, TX 75708-3154, USA
| | - Xisheng Wang
- The Department of Pulmonary Immunology, University of Texas Health Science Center at Tyler, 11937 US HWY 271, Tyler, TX 75708-3154, USA
| | - RamaKrishna Vankayalapati
- The Department of Pulmonary Immunology, University of Texas Health Science Center at Tyler, 11937 US HWY 271, Tyler, TX 75708-3154, USA
| | - Buka Samten
- The Department of Pulmonary Immunology, University of Texas Health Science Center at Tyler, 11937 US HWY 271, Tyler, TX 75708-3154, USA.
| |
Collapse
|
7
|
|
8
|
Safe IP. Tuberculosis associated with transient hemolytic anemia responsive to tuberculosis chemotherapy: a case report. Braz J Infect Dis 2013; 17:110-1. [PMID: 23290474 PMCID: PMC9427378 DOI: 10.1016/j.bjid.2012.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Revised: 04/14/2012] [Accepted: 04/14/2012] [Indexed: 11/29/2022] Open
Affiliation(s)
- Izabella Picinin Safe
- Corresponding author at: Fundação de Medicina Tropical – Dr. Heitor Vieira Dourado (FMT-HVD), Avenida Pedro Teixeira 25, Dom Pedro, Manaus, 69040-000, AM, Brazil. Tel.: +55 92 21273442.
| |
Collapse
|
9
|
Wu B, Rong R. Cold agglutinin syndrome with severe haemolytic anaemia in a patient diagnosed of disseminated tuberculosis and concomitant Mycoplasma pneumoniae infection. Transfus Med 2012; 22:151-2. [PMID: 22380788 DOI: 10.1111/j.1365-3148.2012.01141.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
MESH Headings
- Adult
- Anemia, Hemolytic/diagnosis
- Anemia, Hemolytic/etiology
- Anemia, Hemolytic/therapy
- Anemia, Hemolytic, Autoimmune/diagnosis
- Anemia, Hemolytic, Autoimmune/etiology
- Anemia, Hemolytic, Autoimmune/therapy
- Humans
- Male
- Mycoplasma pneumoniae
- Pneumonia, Mycoplasma/complications
- Pneumonia, Mycoplasma/diagnosis
- Pneumonia, Mycoplasma/therapy
- Syndrome
- Tuberculosis/complications
- Tuberculosis/diagnosis
- Tuberculosis/therapy
Collapse
|
10
|
Chen HC, Huang LT, Wang HC. Severe Hemolytic Anemia due to Active Pulmonary Tuberculosis. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/s1877-8607(11)60009-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
11
|
Cummins D, Markham D, Ardeman S, Lubenko A. Severe thrombocytopenia in tuberculosis. CLINICAL AND LABORATORY HAEMATOLOGY 2008; 15:150-2. [PMID: 8348779 DOI: 10.1111/j.1365-2257.1993.tb00142.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
|
12
|
Chmielik LP, Ziolkowski J, Koziolek R, Kulus M, Chmielik M. Ear tuberculosis: clinical and surgical treatment. Int J Pediatr Otorhinolaryngol 2008; 72:271-4. [PMID: 18093666 DOI: 10.1016/j.ijporl.2007.10.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2007] [Revised: 10/10/2007] [Accepted: 10/11/2007] [Indexed: 10/22/2022]
Abstract
Two main points are discussed in this paper: First, the changing picture of the clinical process of tuberculosis, and second, various diagnostic problems caused by extra-pulmonary forms. We have analysed a case of ear tuberculosis in a child, and drawn the following conclusions: Directed chemotherapy is the primary method of treatment, and surgical methods should be used to provide tissue for bacteriological and histopathological analysis, to enable an early diagnosis during the first stage of the disease, and in other atypical cases.
Collapse
|
13
|
Khemiri M, Zouari S, Barsaoui S. Autoimmune bicytopenia in pulmonary tuberculosis. Report of a pediatric case. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.rmedc.2008.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
14
|
Alioglu B, Avci Z, Ozyurek E, Ozbek N. Anti-D immunoglobulin-induced prolonged intravascular hemolysis and neutropenia. J Pediatr Hematol Oncol 2007; 29:636-9. [PMID: 17805040 DOI: 10.1097/mph.0b013e318142ac5f] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Intravenous anti-D immunoglobulin (anti-D IVIG) is indicated for the treatment of immune thrombocytopenic purpura (ITP) in nonsplenectomized patients who are Rh(D)-positive. Recent reports have described episodes of intravascular hemolysis after anti-D IVIG. We report an adolescent boy with chronic ITP who required multiple transfusions of erythrocyte suspensions when intravascular hemolysis persisted for 6 months after anti-D IVIG treatment. He did not have hemolytic anemia before treatment. The features of our case suggest that pediatric patients treated with anti-D IVIG for ITP should be closely monitored for signs and symptoms of hemoglobinemia and/or hemoglobinuria, and clinically significant anemia. Our case proposes that persistence of immune hemolysis after this treatment may be related to presence of previously defined predisposing agents like tuberculosis and antituberculous therapy. Our observations suggest that steroid therapy can be effective in patients who developed prolonged hemolytic anemia and neutropenia after anti-D IVIG therapy.
Collapse
Affiliation(s)
- Bulent Alioglu
- Department of Pediatric Hematology, Baskent University Faculty of Medicine, Ankara, Turkey.
| | | | | | | |
Collapse
|
15
|
|
16
|
Uzun O, Turgut M, Erkan L. Two unusual hematologic presentations of tuberculosis. Ann Saudi Med 2005; 25:496-500. [PMID: 16438462 PMCID: PMC6089737 DOI: 10.5144/0256-4947.2005.496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/01/2005] [Indexed: 11/22/2022] Open
Affiliation(s)
- Oğuz Uzun
- Department of Pulmonary Diseases, Ondokuz Mayis University, School of Medicine, Samsun, Turkey.
| | | | | |
Collapse
|
17
|
Bonadio M, Carpi A, Gigli C, Virgone E, Carneglia L. Epidemiological and clinical features of 139 patients with tuberculosis at a teaching hospital in Italy (Pisa, 1996-2000). Biomed Pharmacother 2005; 59:127-31. [PMID: 15795106 DOI: 10.1016/j.biopha.2004.04.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2004] [Accepted: 04/06/2004] [Indexed: 10/25/2022] Open
Abstract
In order to describe epidemiologic and clinical features of patients with tuberculosis (TB) identified recently in the hospital of Pisa (Tuscany, Italy), a retrospective study of all cases of TB notified to the Local Public Health Service during January 1996-December 2000 was performed. The diagnosis of TB was made following the criteria of the WHO. A total of 139 patients affected by TB were identified. Diagnosis was microbiologically proved in 81 patients. Mean age was 53.8+/-20.5 S.D. yrs. Thirty-five (25.2%) patients were extra European community citizens (mostly from Africa). The incidence of TB (N/100.000) was 8.4 in 1996 and 6.8 in 2000. Sixty-eight point three per cent of patients had pulmonary TB, 24.5% extrapulmonary and 7.2% mixed TB. The rate of extrapulmonary TB was 15.9% and 39.2% in the 1996-98 and in the 1999-2000 periods, respectively (p = 0.002). Extrapulmonary TB was more frequent in extra European community citizens (42.8%) than in Italian ones (18.3%), p = 0.003. Seven patients were presenting also advanced HIV infection. Microscopic examination for acid fast bacilli in sputum or bronchial secretion resulted negative in 17.4% of proved pulmonary TB (positive culture for Mycobacterium tuberculosis). The chest x-rays showed pleural effusion in 19 patients. Pulmonary cavitation was documented in 15 patients with negative chest x-rays. Fever was not present in 42.4% of the patients at the moment of diagnosis. Three point eight percent of the isolated strains of M. tuberculosis were in vitro multidrug-resistant. The data presented showed an important rate of TB in Pisa. We have yet to understand if the decreased rate observed in 2000 represents a new trend as reported in other North American and European countries. The rate of extrapulmonary TB shows a trend to increase accordingly to recent literature. The isolation rate of multidrug-resistant strains of M. tuberculosis in Pisa seems to be similar to the rates reported in other areas of Europe.
Collapse
Affiliation(s)
- Mario Bonadio
- Department of Medicine, Infectious Diseases Section, University-Hospital of Pisa, Italy.
| | | | | | | | | |
Collapse
|
18
|
Bakhshi S, Rao IS, Jain V, Arya LS. Autoimmune hemolytic anemia complicating disseminated childhood tuberculosis. Indian J Pediatr 2004; 71:549-51. [PMID: 15226569 DOI: 10.1007/bf02724302] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
An 8-year-old girl presented with severe autoimmune hemolytic anemia (AIHA) in association with mediastinal widening. Biopsy of mediastinal lymph node confirmed the diagnosis of tuberculosis. A diagnosis of disseminated tuberculosis in association with AIHA was made, and the patient was treated with steroids and antitubercular therapy. This is the first report case of AIHA in association with childhood tuberculosis; we also discuss other reported cases of AIHA in association with adult tuberculosis in English literature.
Collapse
Affiliation(s)
- Sameer Bakhshi
- Division of Hematology Oncology, All India Institute of Medical Sciences, New Delhi, India.
| | | | | | | |
Collapse
|
19
|
Kuo PH, Yang PC, Kuo SS, Luh KT. Severe immune hemolytic anemia in disseminated tuberculosis with response to antituberculosis therapy. Chest 2001; 119:1961-3. [PMID: 11399734 DOI: 10.1378/chest.119.6.1961] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Severe hemolytic anemia in patients with disseminated tuberculosis is exceedingly rare. We report an episode of Coombs'-positive hemolytic anemia in a previously healthy young man with miliary tuberculosis, resulting in a hemoglobin level of 5 g/dL and an undetectable haptoglobin level. The patient responded well to treatment with antituberculosis drugs, and the results of the direct Coombs' test became negative without the need of blood transfusion or steroid therapy.
Collapse
Affiliation(s)
- P H Kuo
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | | | | | | |
Collapse
|
20
|
Diagnostic Standards and Classification of Tuberculosis in Adults and Children. This official statement of the American Thoracic Society and the Centers for Disease Control and Prevention was adopted by the ATS Board of Directors, July 1999. This statement was endorsed by the Council of the Infectious Disease Society of America, September 1999. Am J Respir Crit Care Med 2000; 161:1376-95. [PMID: 10764337 DOI: 10.1164/ajrccm.161.4.16141] [Citation(s) in RCA: 1055] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
|
21
|
dos Santos VM, dos Reis MA, Resende MA, dos Santos JA, Bernardini AI, de Souza LB. [Miliary tuberculosis - report of a case]. Rev Soc Bras Med Trop 1998; 31:315-8. [PMID: 9612023 DOI: 10.1590/s0037-86821998000300009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
This is a case report of generalized miliary tuberculous infection in a 80-year old white male without the acquired immunodeficiency syndrome, whose death was caused by progressive hematogenous seeding similar to those cases of preantibiotic era. The importance of autopsy studies to uncover silent or protean infections specially in cases of cryptic or chronic hematogenous miliary tuberculosis, is emphasized.
Collapse
Affiliation(s)
- V M dos Santos
- Departamento de Clínica Médica, Faculdade de Medicina do Triângulo Mineiro, Uberaba, MG
| | | | | | | | | | | |
Collapse
|
22
|
Affiliation(s)
- P A LoBue
- University of California San Diego, USA
| | | | | | | |
Collapse
|
23
|
Patel K, Kelsey PR. Acute myeloid leukaemia complicated by anergic tuberculosis. CLINICAL AND LABORATORY HAEMATOLOGY 1996; 18:53-4. [PMID: 9118607 DOI: 10.1111/j.1365-2257.1996.tb00740.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A case of acute myeloid leukaemia presenting as pyrexia of unknown origin and weight loss with pancytopenia is described. Initial investigations revealed trilineage myelodysplasia which evolved into acute myeloid leukaemia within 2 weeks of presentation. He was commenced on a standard induction regimen consisting of idarubicin, Ara-C and thioguanine. Throughout his hospital stay he remained febrile. In spite of exhaustive investigations no cause for the pyrexia was found nor did he respond to any form of treatment. He died after 9 weeks in hospital. His post-mortem examination revealed widespread disseminated tuberculosis without any reactive inflammatory tissue response or granuloma formation.
Collapse
Affiliation(s)
- K Patel
- Department of Clinical Haematology, Blackpool Victoria Hospital NHS Trust, Blackpool, UK
| | | |
Collapse
|
24
|
|
25
|
Luman W, Middleton WG, Gray RS. Acute myelocytic leukaemia presenting as anergic pulmonary tuberculosis. Scott Med J 1994; 39:116-7. [PMID: 8778960 DOI: 10.1177/003693309403900407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This case report describes a patient with anergic pulmonary tuberculosis who presented with pyrexia of unknown origin and vasculitis. He did not exhibit any pulmonary symptoms at his initial presentation and developed acute myelocytic leukaemia, a recognised association, during the subsequent course of his illness.
Collapse
MESH Headings
- Aged
- Antitubercular Agents/therapeutic use
- Diagnosis, Differential
- Fever of Unknown Origin/etiology
- Hematologic Diseases/etiology
- Humans
- Immunocompromised Host
- Leukemia, Myeloid, Acute/complications
- Leukemia, Myeloid, Acute/diagnosis
- Leukemia, Myeloid, Acute/immunology
- Male
- Tuberculosis, Pulmonary/complications
- Tuberculosis, Pulmonary/diagnosis
- Tuberculosis, Pulmonary/drug therapy
Collapse
Affiliation(s)
- W Luman
- Gastrointestinal Unit, Western General Hospital, Edinburgh
| | | | | |
Collapse
|
26
|
Hui KP, Chin NK, Chan TB, Tan WC, Chow K, Brown A, Kumarasinghe G. Platelet count as an independent predictor differentiating between tuberculosis and non-tuberculosis pneumonia. TUBERCLE AND LUNG DISEASE : THE OFFICIAL JOURNAL OF THE INTERNATIONAL UNION AGAINST TUBERCULOSIS AND LUNG DISEASE 1994; 75:157. [PMID: 8032052 DOI: 10.1016/0962-8479(94)90048-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
|
27
|
Richards EM, Shneerson JM, Baglin TP. Thrombocytopenia responding to empirical antituberculous therapy. CLINICAL AND LABORATORY HAEMATOLOGY 1994; 16:89-90. [PMID: 8039352 DOI: 10.1111/j.1365-2257.1994.tb00392.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
|
28
|
Hematologic Changes in Tuberculosis. Tuberculosis (Edinb) 1994. [DOI: 10.1007/978-1-4613-8321-5_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
29
|
Miliary Tuberculosis. Tuberculosis (Edinb) 1994. [DOI: 10.1007/978-1-4613-8321-5_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
30
|
Campos JM, Vanazzi E, Garrido JR, Mader LF, Ferreira G. Non-reactive tuberculosis in an infant. TUBERCLE AND LUNG DISEASE : THE OFFICIAL JOURNAL OF THE INTERNATIONAL UNION AGAINST TUBERCULOSIS AND LUNG DISEASE 1993; 74:408-9. [PMID: 8136497 DOI: 10.1016/0962-8479(93)90087-e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
|
31
|
Cassim KM, Gathiram V, Jogessar VB. Pancytopaenia associated with disseminated tuberculosis, reactive histiocytic haemophagocytic syndrome and tuberculous hypersplenism. TUBERCLE AND LUNG DISEASE : THE OFFICIAL JOURNAL OF THE INTERNATIONAL UNION AGAINST TUBERCULOSIS AND LUNG DISEASE 1993; 74:208-10. [PMID: 8369517 DOI: 10.1016/0962-8479(93)90014-o] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
A 38-year-old black male is reported with a rare combination of disseminated tuberculosis together with a reactive histiocytic haemophagocytic syndrome and tuberculosis hypersplenism. Tuberculosis and histiocytic haemophagocytosis were diagnosed on bone marrow examination. The pancytopaenia and splenomegaly which were present on admission did not resolve despite adequate anti-tuberculosis chemotherapy. Prior to splenectomy the patient continued to have a marked thrombocytopenia which resulted in recurrent bouts of epistaxis; splenectomy together with tuberculostatic therapy was curative for the condition. The patient remains well with normal blood counts 1 year later.
Collapse
Affiliation(s)
- K M Cassim
- Department of Medicine, University of Natal, South Africa
| | | | | |
Collapse
|
32
|
Goebel RA. Thrombocytopenia. Emerg Med Clin North Am 1993. [DOI: 10.1016/s0733-8627(20)30642-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
33
|
Lombard EH, Mansvelt EP. Haematological changes associated with miliary tuberculosis of the bone marrow. TUBERCLE AND LUNG DISEASE : THE OFFICIAL JOURNAL OF THE INTERNATIONAL UNION AGAINST TUBERCULOSIS AND LUNG DISEASE 1993; 74:131-5. [PMID: 8324206 DOI: 10.1016/0962-8479(93)90041-u] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The peripheral blood and bone marrow findings in 25 patients found to have tuberculous granulomata on bone marrow examination were examined to determine whether specific haematological findings are associated with tuberculous infiltration of the bone marrow. All the patients had one abnormality or more on their full blood count. The presence of a peripheral lymphopaenia was the single factor common to all 25 patients studied. The peripheral lymphopaenia was only associated with bone marrow lymphopaenia in 14% of patients. Other findings of note were an association of peripheral monocytopaenia and absence of giant cells in the granulomata, and decreased iron stores in almost a third of the total number of patients. The relevance of the lymphopaenia, monocytopaenia and decreased iron stores are discussed and we propose that the absence of a peripheral lymphopaenia makes it very unlikely that there will be tuberculous localization in the bone marrow.
Collapse
Affiliation(s)
- E H Lombard
- Department of Haematological Pathology, University of Stellenbosch and Tygerberg Hospital, Parowvallei, Cape Province
| | | |
Collapse
|
34
|
|
35
|
Fox BC, Ross DD, Huang AB, Gabrielson EW, Furth PA. Mycobacterial disease associated with aplastic anaemia. J Infect 1989; 19:157-65. [PMID: 2681429 DOI: 10.1016/s0163-4453(89)91964-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Haematological changes associated with infectious disease are relatively common but true aplastic anaemia secondary to infection is rare. We describe a patient wit disseminated Mycobacterium avium-intracellulare infection and who had a histologically proven remission of his aplastic anemia accompanying antimycobacterial therapy. We also review the literature on the haematological changes associated with mycobacterial infections and other infectious causes of aplastic anaemia.
Collapse
Affiliation(s)
- B C Fox
- Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore
| | | | | | | | | |
Collapse
|
36
|
Mahmood KH, Stanford JL, Machin S, Watts M, Stuart FA, Pritchard DG. The haematological values of European badgers (Meles meles) in health and in the course of tuberculosis infection. Epidemiol Infect 1988; 101:231-7. [PMID: 3181308 PMCID: PMC2249375 DOI: 10.1017/s0950268800054145] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Captive, healthy, adult badgers have blood containing haemoglobin at 13.3 g/dl, and 8.4 x 10(12)/l red cells with an MCV of 46.2 fl and an MCH of 15.6 pg. They have 5.1 x 10(9) white cells/l of which 3.29 x 10(9) are polymorphs, 1.49 x 10(9) are lymphocytes, 0.26 x 10(9) are monocytes, 0.07 x 10(9) are eosinophils and 0.01 x 10(9) are basophils. These values are somewhat less in adult animals just trapped from the wild, and are lower still in wild cubs. Changes associated with tuberculosis are a rise, and then a fall in red blood count and white blood count, an increase in the proportion of polymorphs and monocytes and a fall in lymphocytes late in the disease. This picture is similar to that seen in widespread, disseminated, tuberculin negative, tuberculosis in humans, a type of disease similar to that occurring in many badgers. BCG vaccination of badgers did not produce any measurable change in the blood picture.
Collapse
Affiliation(s)
- K H Mahmood
- Department of Microbiology, School of Pathology, Middlesex Hospital Medical School, London
| | | | | | | | | | | |
Collapse
|
37
|
|
38
|
Affiliation(s)
- M R Holdiness
- Professional Medical and Research Corporation, Metairie (New Orleans), Louisiana 70005-9043
| |
Collapse
|
39
|
Baynes RD, Bothwell TH, Flax H, McDonald TP, Atkinson P, Chetty N, Bezwoda WR, Mendelow BV. Reactive thrombocytosis in pulmonary tuberculosis. J Clin Pathol 1987; 40:676-9. [PMID: 3611396 PMCID: PMC1141061 DOI: 10.1136/jcp.40.6.676] [Citation(s) in RCA: 32] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The incidence of reactive thrombocytosis in active pulmonary tuberculosis was studied in 122 patients. Thrombocytosis was common, platelet counts often exceeding 1 X 10(12)/1. A significant inverse correlation was noted between the mean platelet volume and the platelet count (r = -0.54, p less than 0.0001). Interval estimation suggested that this relation was non-linear. Further studies were done in a small group of six patients. Platelet survival was considerably shortened, the platelets aggregated excessively in vitro, serum concentrations of thrombopoiesis stimulating activity were raised, and serotonin uptake and release were within normal limits. The degree of thrombocytosis correlated significantly with the degree of inflammation measured by the erythrocyte sedimentation rate (r = 0.40, p less than 0.003) and serum C-reactive protein concentration (r = 0.35, p less than 0.008).
Collapse
|
40
|
Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 51-1986. A 44-year-old homosexual man with back pain and an interstitial pulmonary infiltrate. N Engl J Med 1986; 315:1660-8. [PMID: 3024004 DOI: 10.1056/nejm198612253152607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
|
41
|
|
42
|
Barnes N, Bellamy D, Ireland R, Parsons V. Pulmonary tuberculosis complicated by haemophagocytic syndrome and rifampicin-induced tubulointerstitial nephritis. ACTA ACUST UNITED AC 1984. [DOI: 10.1016/0007-0971(84)90175-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
43
|
Omar MA, Jogessar VB, Kamdar MC. Thrombocytosis associated with tuberculous peritonitis. TUBERCLE 1983; 64:295-6. [PMID: 6659077 DOI: 10.1016/0041-3879(83)90027-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
A young African female is described who showed marked thrombocytosis (platelet count 1372 X 10(9)/l) in association with tuberculous peritonitis, a rare association.
Collapse
|
44
|
Abstract
Thrombocytopenia associated with Mycobacterium tuberculosis infection developed concurrently in a mother and son. Antiplatelet antibodies were demonstrated in the serum of both patients. It is suggested that this and possibly other hematologic complications associated with tuberculosis are immune mediated.
Collapse
|
45
|
Stanford CF, Bittles A. Vitamin B12 estimation and rifampicin. TUBERCLE 1982; 63:236-7. [PMID: 7179490 DOI: 10.1016/s0041-3879(82)80039-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
|
46
|
Jenkins PF, Williams TD, Campbell IA. Neutropenia with each standard antituberculosis drug in the same patient. BRITISH MEDICAL JOURNAL 1980; 280:1069-70. [PMID: 7388400 PMCID: PMC1601198 DOI: 10.1136/bmj.280.6221.1069] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
|
47
|
|