Extrapulmonary Tuberculosis in the Bone Marrow: A Case of Pancytopenia and Chronic Corticosteroid Use

TL;DR

A rare case of bone marrow tuberculosis in an immunocompromised patient with pancytopenia is reported, highlighting diagnostic challenges and treatment outcomes.

Contribution

This paper presents a novel case report of bone marrow TB in a patient with chronic corticosteroid use, emphasizing diagnostic and treatment complexities.

Findings

Bone marrow biopsy confirmed tuberculosis in a patient with nonspecific symptoms and pancytopenia.

Chronic corticosteroid use and immunocompromised state complicated diagnosis and treatment of TB.

Antitubercular therapy led to clinical improvement and resolution of cytopenia.

Abstract

Bone marrow tuberculosis (TB) is a rare but severe form of extrapulmonary TB, often presenting with nonspecific symptoms such as fatigue, weakness, and cytopenia, making diagnosis challenging.

We report the case of a 71-year-old male with a history of pituitary surgery and chronic corticosteroid use, who presented with pancytopenia, hyponatremia, and a chronic productive cough. Initial investigations, including chest CT, abdominal and pelvic ultrasound, liver elastography, dynamic liver MRI, blood cultures (from peripheral blood), and sputum cultures (from expectorated sputum), were inconclusive. A bone marrow biopsy revealed caseating granulomas, and acid-fast staining confirmed Mycobacterium tuberculosis.

The patient was initiated on a 12-month antitubercular therapy regimen, extended due to the disseminated nature of bone marrow TB and the patient's immunocompromised state from chronic corticosteroid use, leading to clinical improvement and resolution of cytopenia.

This case highlights the diagnostic complexities of bone marrow TB, particularly in immunocompromised individuals, and underscores the importance of considering TB in patients with unexplained hematological abnormalities. Limited literature on this condition emphasizes the need for further research to enhance diagnostic accuracy and optimize treatment strategies.

Early recognition and appropriate management are crucial for improving outcomes in this rare but serious manifestation of TB.

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