Journal of the Chinese Medical Association
Volume 73, Issue 4 , Pages 208-211, April 2010

Severe Extensive Bone Marrow Necrosis From Miliary Tuberculosis Without Granulomas and Pulmonary Presentations

  • Yun-Hsuan Lee

      Affiliations

    • Department of Medicine, Taipei, Taiwan, R.O.C.
    • National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • ,
  • Ying-Chung Hong

      Affiliations

    • Division of Hematology and Oncology, Taipei, Taiwan, R.O.C.
    • National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • ,
  • Ching-Fen Yang

      Affiliations

    • Department of Pathology and Laboratory Medicine, Taipei, Taiwan, R.O.C.
    • National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • ,
  • Hung-Ta Wu

      Affiliations

    • Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • ,
  • Ling-Ju Huang

      Affiliations

    • Division of Infectious Diseases, Taipei, Taiwan, R.O.C.
    • National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • ,
  • Cheng-Hwai Tzeng

      Affiliations

    • Division of Hematology and Oncology, Taipei, Taiwan, R.O.C.
    • National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • ,
  • Chun-Yu Liu

      Affiliations

    • Division of Infectious Diseases, Taipei, Taiwan, R.O.C.
    • National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • Corresponding Author InformationCorrespondence to: Dr Chun-Yu Liu, Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei 112, Taiwan, R.O.C.

Received 2 September 2009; received in revised form 28 January 2010

Article Outline

Bone marrow necrosis (BMN) is a rare clinicopathologic entity caused by hypoxemia after failure of the microcirculation, which frequently manifests with bone pain, fever, and peripheral cytopenia. In most reported cases of BMN resulting from miliary tuberculosis (TB), the presence of marrow granulomas, pulmonary infiltrates and/or extrapulmonary involvement is common. We report a female patient with extensive BMN from miliary TB, whose initial presentation was only severe peripheral cytopenia with extensive marrow necrosis, with neither evident pulmonary manifestations nor granulomas in the marrow biopsy. Serial Ziehl–Neelsen stains and Mycobacterium tuberculosis cultures were negative. The diagnosis of suspected miliary TB was made by consecutive positive results from polymerase chain reaction analysis for TB of marrow samples at 2 separate examination time points and a good treatment response to anti-TB therapy. Magnetic resonance imaging showed a geographic pattern of multiple signal abnormalities, indicating bone infarcts over the bilateral iliac bones and T-L-spine vertebral bodies, compatible with extensive BMN. The unusual presentation of extensive BMN with severe peripheral cytopenia in the absence of granulomas or pulmonary presentations should alert clinical physicians in epidemic areas. We discuss the use of polymerase chain reaction analysis for TB and magnetic resonance imaging for diagnosis of these patients.

Key Words:  bone marrow necrosis , miliary tuberculosis , pancytopenia

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PII: S1726-4901(10)70043-5

doi:10.1016/S1726-4901(10)70043-5

Journal of the Chinese Medical Association
Volume 73, Issue 4 , Pages 208-211, April 2010

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