Bone marrow granulomas in a high tuberculosis prevalence setting

Abstract

Granulomas were reported in 0.3% to 3% of bone marrow biopsies. The aim of the study was to evaluate the incidence and etiology of bone marrow granulomas (BMGs) in the West China Hospital, which located at a high tuberculosis (TB) prevalence area in China.A retrospective case review was performed on 11,339 bone marrow biopsies at the West China Hospital of Sichuan University between January 2011 and December 2015. Cases with BMGs were retrieved and their clinical data and histopathological features were collected, examined, and analyzed.Out of 11,339, 110 cases showed granulomatous lesions in the bone marrow biopsies (0.97%). Etiologies were indentified in 80 cases (72.8%), with infections being the most common (64.5%), following by malignancies (4.5%) and autoimmune diseases (3.6%). Among infectious cases, 87.32% (62/71) cases were diagnosed as TB, a positive acid-fast stain or/and polymerase chain reaction (PCR) result for mycobacterium TB DNA fragment amplification was obtained for 35 cases. In 30 cases (27.27%), a definite diagnosis could not be established.In a TB high prevalence region in China, with a combined histological, clinical, serological, and molecular approach, we were able to clarify the cause in 72.73% of the bone marrow granulomatous cases. TB is the most common underlying etiologies. Therefore, acid-fast stain and quantitative PCR for mycobacterium TB DNA amplification are recommended as a routine for bone marrow biopsies in TB high prevalence regions.

Leishmaniasis Diagnosis via Metagenomic Next-Generation Sequencing

“…In contrast, bone marrow mNGS is a good choice for Leishmania detection. In addition to Leishmania , many other pathogens, such as Brucella (Tuon et al, 2017 ), Salmonella (Crump et al, 2015 ), Mycobacterium tuberculosis (Wang et al, 2018 ), Histoplasma capsulatum (Medina-Pinon et al, 2017 ), and Penicillium marneffei (Qin et al, 2015 ), can infect the bone marrow. When pathogens are unknown, high-throughput mNGS can be used for identification.…”

Diagnostic utility of bone marrow examination in evaluation of fever: a descriptive study on 98 immunocompetent adults from a tertiary care institute in south India

“…However, a definitive aetiology was not identified in 30 cases, which accounted for 27.2% of the total. 10 These findings highlight the fact that while TB still remains the commonest aetiology of pyrexia and BMGs, especially in the high prevalence Southeast Asian region, Salmonellosis should also be considered as a close differential in such cases. As previously reviewed by our own group, erythrophagocytosis within histiocytic granulomas on trephine biopsy sections should be correlated with culture characteristics to confirm a typhoidal granuloma and prevent unnecessary, potentially toxic anti-tubercular therapy (Figure 4).…”

“…7,9 In contrast to the above, Wang et al reported the highest incidence of infective aetiologies of BMGs (80/ 110 cases [72.8%]) from China. 10 TB was the most common cause (n ¼ 62), followed by fungi (n ¼ 4), typhoid or paratyphoid fever (n ¼ 3), and brucellosis (n ¼ 2). In 27 of 62 cases of tubercular granulomas, the diagnosis was based on marrow morphology in correlation with clinical presentation and excellent response to anti-tubercular therapy.…”

Pediatric isoniazid-resistant tuberculosis of the bone marrow manifesting as hemophagocytic syndrome: A case report

“…There is scarce literatures worldwide regarding the epidemiology of the incidence of TB of the bone marrow. In a retrospective study in an area with high TB incidence in China, only 14 out of 110 patients with bone marrow granulomas tested culture positive for acid-fast bacilli or TB-DNA qPCR, which are microbiological evidence of TB ( 12 ). This demonstrated that TB of the bone marrow is difficult to diagnose except for some severe disseminated cases which manifested specific TB clinical characteristics.…”