Pancytopenia with Hypocellular Bone Marrow due to Miliary Tuberculosis: An Unusual Presentation

Demiroǧ, Haluk; Lu, Jiwen; Özcebe, Osman; Özdemir, Oktay; Sungur, Arzu; Dündar, Semra

doi:10.1159/000204246

Cited by 13 publications

(7 citation statements)

References 10 publications

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“…Although in some cases of sideroblastic anaemia large pharmacological doses of pyridoxine can correct the haematological abnormality, associated pyridoxine deficiency is unusual 4 , 6 . On the other hand, TB may present with protean haematologic manifestations including anaemia of chronic disease with an increase in iron stores 7 , 8 …”

Section: Discussionmentioning

confidence: 99%

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VITAMIN B₆ RESPONSIVE SIDEROBLASTIC ANAEMIA IN A PATIENT WITH TUBERCULOSIS

Demiroǧlu

Dündar

1997

Int J Clinical Practice

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SUMMARY A 39‐year‐old woman was admitted with fatigue, weight loss and fever. Nothing, except skin pallor could be found on physical examination. Her haemoglobin (Hb) was 6.3 g/dl. The blood picture showed dimorphic red cell changes and there were dyserythropoiesis and ring sideroblasts in the bone marrow. After detailed investigations, she was diagnosed with tuberculosis, and anaemia was assigned to chronic disease. With anti‐tuberculosis therapy (including isoniazid), her Hb and bone marrow findings returned to normal. After cessation of therapy, Hb fell to 8.9 g/dl. Bone marrow examination again showed dyserythropoietic morphologic abnormalities and ring sideroblasts. No reason could be identified to explain the recurrence of anaemia. When we realised that preparations of isoniazid included vitamin B6 to prevent the development of sideroblastic anaemia, we challenged with pyridoxin 200 mg daily. Her Hb rose to 14.6 g/dl. We suggest that in any cases with sideroblastic anaemia, if no cause can be identified, or anaemia persists or recurs despite therapy, pyridoxine therapy should be instituted.

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Section: Discussionmentioning

confidence: 99%

“…4 • 6 On the other hand, TB may present with protean haematologic manifestations including anaemia of chronic disease with an increase in iron stores. 7 • 8…”

Section: Discussionmentioning

confidence: 99%

VITAMIN B₆ RESPONSIVE SIDEROBLASTIC ANAEMIA IN A PATIENT WITH TUBERCULOSIS

Demiroǧlu

Dündar

1997

Int J Clinical Practice

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“…In general, tuberculosis-associated hematologic mani festations are monocytosis, leukemoid reactions, leukope nia, anemia, basophilia, disseminated intravascular coagulation and rarely pancytopenia [13][14][15][16]. Tuberculo sis-associated hemophagocytic syndrome is an unusual hematologic manifestation.…”

Section: Discussionmentioning

confidence: 99%

Tuberculosis-Associated Hemophagocytic Syndrome in a Hemodialysis Patient: Case Report and Review of the Literature

Yang¹,

Lee

Kim

et al. 1996

Nephron

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We present an unusual hematologic manifestation of tuberculosis in a hemodialysis patient. A 37-year-old man was admitted because of fever, anorexia and weight loss which developed 3 months earlier. He previously received a renal transplant and commenced hemodialysis 1 year ago. Physical examination revealed hepatomegaly, and peripheral blood counts revealed pancytopenia. The delayed bone marrow biopsy demonstrated marked hemophagocytosis, granuloma and tubercle bacilli by the acid-fast stain. The clinical course was fatal and he died without definite treatment. Through this case, we would like to recommend early bone marrow biopsy and antituberculosis therapy if fever of unknown origin, anorexia, weight loss, hepatomegaly and pancytopenia develop in patients undergoing dialysis.

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“…Disseminated tuberculosis ( 368 – 371 ) or even disseminated BCG vaccination ( 372 ) can induce BM hypoplasia and peripheral cytopenia. The fact that tuberculosis-induced AHF occurs only in disseminated tuberculosis instead of in isolated pulmonary tuberculosis suggests that tuberculosis can infect hematopoietic tissues ( 373 ) or the gastrointestinal tract ( 34 , 35 , 181 , 349 ).…”

Section: Particular Attention Should Be Given To Gut Inflammatory Dis...mentioning

confidence: 99%

When inflammatory stressors dramatically change, disease phenotypes may transform between autoimmune hematopoietic failure and myeloid neoplasms

Zhao,

Ju,

Xiu

et al. 2024

Front. Immunol.

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Aplastic anemia (AA) and hypoplastic myelodysplastic syndrome are paradigms of autoimmune hematopoietic failure (AHF). Myelodysplastic syndrome and acute myeloid leukemia are unequivocal myeloid neoplasms (MNs). Currently, AA is also known to be a clonal hematological disease. Genetic aberrations typically observed in MNs are detected in approximately one-third of AA patients. In AA patients harboring MN-related genetic aberrations, a poor response to immunosuppressive therapy (IST) and an increased risk of transformation to MNs occurring either naturally or after IST are predicted. Approximately 10%–15% of patients with severe AA transform the disease phenotype to MNs following IST, and in some patients, leukemic transformation emerges during or shortly after IST. Phenotypic transformations between AHF and MNs can occur reciprocally. A fraction of advanced MN patients experience an aplastic crisis during which leukemic blasts are repressed. The switch that shapes the disease phenotype is a change in the strength of extramedullary inflammation. Both AHF and MNs have an immune-active bone marrow (BM) environment (BME). In AHF patients, an inflamed BME can be evoked by infiltrated immune cells targeting neoplastic molecules, which contributes to the BM-specific autoimmune impairment. Autoimmune responses in AHF may represent an antileukemic mechanism, and inflammatory stressors strengthen antileukemic immunity, at least in a significant proportion of patients who have MN-related genetic aberrations. During active inflammatory episodes, normal and leukemic hematopoieses are suppressed, which leads to the occurrence of aplastic cytopenia and leukemic cell regression. The successful treatment of underlying infections mitigates inflammatory stress-related antileukemic activities and promotes the penetration of leukemic hematopoiesis. The effect of IST is similar to that of treating underlying infections. Investigating inflammatory stress-powered antileukemic immunity is highly important in theoretical studies and clinical practice, especially given the wide application of immune-activating agents and immune checkpoint inhibitors in the treatment of hematological neoplasms.

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Pancytopenia with Hypocellular Bone Marrow due to Miliary Tuberculosis: An Unusual Presentation

Cited by 13 publications

References 10 publications

VITAMIN B₆ RESPONSIVE SIDEROBLASTIC ANAEMIA IN A PATIENT WITH TUBERCULOSIS

VITAMIN B₆ RESPONSIVE SIDEROBLASTIC ANAEMIA IN A PATIENT WITH TUBERCULOSIS

Tuberculosis-Associated Hemophagocytic Syndrome in a Hemodialysis Patient: Case Report and Review of the Literature

When inflammatory stressors dramatically change, disease phenotypes may transform between autoimmune hematopoietic failure and myeloid neoplasms

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Pancytopenia with Hypocellular Bone Marrow due to Miliary Tuberculosis: An Unusual Presentation

Cited by 13 publications

References 10 publications

VITAMIN B6 RESPONSIVE SIDEROBLASTIC ANAEMIA IN A PATIENT WITH TUBERCULOSIS

VITAMIN B6 RESPONSIVE SIDEROBLASTIC ANAEMIA IN A PATIENT WITH TUBERCULOSIS

Tuberculosis-Associated Hemophagocytic Syndrome in a Hemodialysis Patient: Case Report and Review of the Literature

When inflammatory stressors dramatically change, disease phenotypes may transform between autoimmune hematopoietic failure and myeloid neoplasms

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VITAMIN B₆ RESPONSIVE SIDEROBLASTIC ANAEMIA IN A PATIENT WITH TUBERCULOSIS

VITAMIN B₆ RESPONSIVE SIDEROBLASTIC ANAEMIA IN A PATIENT WITH TUBERCULOSIS