RESUMEN
Disseminated tuberculosis (DTB) often presents with protean clinical manifestations that often leads to potential diagnostic dilemmas. The nonspecific features may include pyrexia of unknown origin, hepatosplenomegaly, lymphadenopathy, meningitis, and a variety of hematological abnormalities, namely anemia, pancytopenia, and leukemoid reaction. Tuberculosis is one of the nonhematopoietic diseases that has been reported in conjunction with myelofibrosis. We, hereby, report a case of DTB with massive splenomegaly, severe pancytopenia, and marrow fibrosis.
Asunto(s)
Mielofibrosis Primaria/diagnóstico , Mielofibrosis Primaria/microbiología , Tuberculosis Miliar/diagnóstico por imagen , Antituberculosos/uso terapéutico , Médula Ósea/microbiología , Médula Ósea/patología , Diagnóstico Diferencial , Resultado Fatal , Humanos , Masculino , Persona de Mediana Edad , Pancitopenia/microbiología , Mielofibrosis Primaria/tratamiento farmacológico , Esplenomegalia/microbiología , Tomografía Computarizada por Rayos X , Tuberculosis Miliar/sangre , Tuberculosis Miliar/tratamiento farmacológicoRESUMEN
BACKGROUND: An 18-month-old female toddler presented with severe vulvar ulcers and pancytopenia with investigations revealing Pseudomonas aeruginosa bacteremia. CASE: A previously healthy 18-month-old female toddler presented with 6 days of fevers, vulvar rash, and ulcers. Vulvar cultures showed Staphylococcus aureus and P aeruginosa. Bloodwork showed pancytopenia and P aeruginosa bacteremia. She started receiving broad-spectrum antibiotics. Bone marrow aspirate revealed a hypocellular marrow with erythroid dysplasia. Vulvar ulcers progressed rapidly, therefore magnetic resonance imaging was performed to rule out necrotizing fasciitis. She was diagnosed with ecthyma gangrenosum (EG). Three months after initial presentation, she was diagnosed with precursor B-cell acute lymphoblastic leukemia. SUMMARY AND CONCLUSION: This case highlights that health care providers should suspect EG when severe vulvar ulcers are present with P aeruginosa infection and neutropenia. Because EG poses significant morbidity and mortality, its presence should prompt aggressive antimicrobial therapy and mobilization of a multidisciplinary team to initiate workup for an underlying immunodeficiency syndrome or malignancy. This case also illustrates that surgical debridement might be avoided in certain patients with EG as long as meticulous wound care and close monitoring with a multidisciplinary team are in place.
Asunto(s)
Ectima/microbiología , Pseudomonas aeruginosa , Infecciones Estafilocócicas/microbiología , Staphylococcus aureus , Enfermedades de la Vulva/microbiología , Antibacterianos/uso terapéutico , Ectima/tratamiento farmacológico , Femenino , Fiebre/microbiología , Humanos , Lactante , Pancitopenia/tratamiento farmacológico , Pancitopenia/microbiología , Infecciones por Pseudomonas/tratamiento farmacológico , Infecciones por Pseudomonas/microbiología , Infecciones Estafilocócicas/tratamiento farmacológico , Úlcera/tratamiento farmacológico , Úlcera/microbiología , Enfermedades de la Vulva/tratamiento farmacológicoAsunto(s)
Ehrlichiosis/diagnóstico , Pancitopenia/microbiología , Anciano , Anaplasma phagocytophilum/genética , Antibacterianos/uso terapéutico , Doxiciclina/uso terapéutico , Ehrlichiosis/tratamiento farmacológico , Enfermedades Endémicas , Femenino , Fiebre/microbiología , Humanos , Massachusetts , Pancitopenia/tratamiento farmacológico , Reacción en Cadena de la Polimerasa , Pérdida de PesoRESUMEN
BACKGROUND: Tuberculosis is a major health problem in the developing world. Diagnosis of extrapulmonary tuberculosis is delayed because the presentation is nonspecific. Extrapulmonary tuberculosis can present with various hematological manifestations, including pancytopenia. Pancytopenia could be due to hypersplenism, maturation arrest, hemophagocytic lymphohistiocytosis, or infiltration of the bone marrow by caseating or noncaseating granulomas causing reversible or irreversible fibrosis. CASE PRESENTATION: We report a case of a 56-year-old Sri Lankan Sinhalese man who presented with pyrexia of known origin with significant loss of weight and loss of appetite. He had mild pallor with mild hepatosplenomegaly. He had high inflammatory markers with pancytopenia in a peripheral blood smear. His chest radiograph was unremarkable, and he had a negative Mantoux test result. A diagnosis of disseminated tuberculosis was made on the basis of caseating tuberculous granulomas in the bone marrow. CONCLUSIONS: Disseminated tuberculosis remains a diagnostic challenge because the presentation is vague and nonspecific. In case of pyrexia of unknown origin with peripheral cytopenia, the possibility of disseminated tuberculosis should be considered, particularly in endemic areas. Simultaneous culture and histopathological examination of the bone marrow is important in such instances, because results of common tests such as chest radiography or Mantoux tests can be negative.
Asunto(s)
Antituberculosos/uso terapéutico , Médula Ósea/microbiología , Pancitopenia/microbiología , Tuberculosis/microbiología , Examen de la Médula Ósea , Fiebre , Humanos , Masculino , Persona de Mediana Edad , Pancitopenia/diagnóstico por imagen , Pancitopenia/tratamiento farmacológico , Radiografía , Resultado del Tratamiento , Tuberculosis/tratamiento farmacológico , Tuberculosis/patología , Pérdida de PesoAsunto(s)
Médula Ósea , Histoplasma , Histoplasmosis , Pancitopenia , Médula Ósea/metabolismo , Médula Ósea/microbiología , Médula Ósea/patología , Histoplasmosis/microbiología , Histoplasmosis/patología , Humanos , Lactante , Masculino , Pancitopenia/metabolismo , Pancitopenia/microbiología , Pancitopenia/patologíaRESUMEN
We here report the case of a 58-year old patient admitted with respiratory distress, oxygen desaturation 65% while breathing ambient air and fever 38.5°C. Blood count showed pancytopenia. Ionogram objectified slight hepatic cytolysis and chest X-ray showed bilateral miliaria. BK research using sputum was negative as well as Genexpert TB test. Anatomopathological examination of the osteomedullar biopsy revealed epitheliogigantocellular granuloma without caseous necrosis and polymerase chain reaction (PCR) showed mycobacterium tuberculosis in osteomedullary biopsy. Liver biopsy showed epithelioid granuloma without caseous necrosis. The diagnosis of multifocal tuberculosis with pulmonary, hematopoietic and hepatic impairment was retained. Miliary Tuberculosis is a severe form of tuberculosis. Bacilloscopies are often negative and the diagnosis can be retained based on other sampling, including cerebrospinal fluid sampling and osteomedullary biopsy. Different kinds of biopsies enable diagnosis in rare cases. PCR, a technique used in molecular biology, has enabled to shorten the window period from disease onset to diagnosis as well as treatment implementation. Miliary tuberculosis can be life-threatening; therefore, sometimes, treatment must be administered before certain diagnosis.
Asunto(s)
Mycobacterium tuberculosis/aislamiento & purificación , Pancitopenia/etiología , Tuberculosis Miliar/diagnóstico , Biopsia , Femenino , Granuloma/diagnóstico , Humanos , Persona de Mediana Edad , Pancitopenia/microbiología , Reacción en Cadena de la Polimerasa/métodos , Tuberculosis Hepática/diagnóstico , Tuberculosis Miliar/complicaciones , Tuberculosis Pulmonar/diagnósticoRESUMEN
BACKGROUND: It is not uncommon that a child with a febrile illness of unknown etiology is admitted to the hospital. When the complete blood count reveals a pancytopenia, the diagnostic process can be a real challenge. CASE PRESENTATION: A 13-year girl of Arab-Berber descent presented with abdominal pain and fever after a holiday in northwestern Morocco. A complete blood count revealed a pancytopenia and blood smear test results revealed spirochetes. Borrelia hispanica was identified by sequencing the 16S ribosomal ribonucleic acid gene. Our patient was treated with tetracyclines and during this treatment we saw full clinical and hematological recovery. CONCLUSIONS: Borrelia hispanica is a known cause of tick-borne relapsing fever and is transmitted to humans through the bite of soft ticks of the genus Ornithodoros (Alectorobius). Although the link between tick-borne relapsing fever and thrombocytopenia has been documented, there are only a few case reports of tick-borne relapsing fever presenting with pancytopenia. To the best of our knowledge, there is no previous report of Borrelia hispanica presenting with pancytopenia.
Asunto(s)
Borrelia/aislamiento & purificación , Pancitopenia/microbiología , Fiebre Recurrente/microbiología , Adolescente , Borrelia/clasificación , Diagnóstico Diferencial , Femenino , Humanos , ARN Ribosómico 16S , Análisis de Secuencia de ADN , Tetraciclinas/administración & dosificaciónAsunto(s)
Macrófagos/patología , Mycobacterium avium/patogenicidad , Pancitopenia/patología , Tuberculosis/patología , Anciano , Antibacterianos/uso terapéutico , Resultado Fatal , Femenino , Humanos , Macrófagos/microbiología , Pancitopenia/tratamiento farmacológico , Pancitopenia/microbiología , Tuberculosis/tratamiento farmacológico , Tuberculosis/microbiologíaAsunto(s)
Fiebre de Origen Desconocido/diagnóstico , Histoplasma/aislamiento & purificación , Histoplasmosis/microbiología , Trasplante de Riñón , Enfermedades Pulmonares Intersticiales/microbiología , Linfohistiocitosis Hemofagocítica/microbiología , Pancitopenia/microbiología , Adolescente , Anfotericina B , Antifúngicos , Médula Ósea/microbiología , Diagnóstico Diferencial , Fungemia/diagnóstico , Fungemia/tratamiento farmacológico , Fungemia/microbiología , Histoplasmosis/diagnóstico , Histoplasmosis/tratamiento farmacológico , Humanos , Infusiones Intravenosas , Enfermedades Pulmonares Intersticiales/diagnóstico , Enfermedades Pulmonares Intersticiales/tratamiento farmacológico , Linfohistiocitosis Hemofagocítica/diagnóstico , Linfohistiocitosis Hemofagocítica/tratamiento farmacológico , Masculino , Pancitopenia/diagnóstico , Pancitopenia/tratamiento farmacológico , Receptores de TrasplantesRESUMEN
Mycobacterium avium complex (MAC) infection is a common complication of the later stages of AIDS. Extrapulmonary infection with MAC in HIV-negative patients is considered uncommon. We report a case of a young female who presented with fever of unknown origin on multiple occasions and failed to be diagnosed with MAC by acid-fast stain initially. Subsequently, the patient presented with pancytopenia due to bone marrow biopsy-proven infection with MAC. The patient was not on any immunosuppressant regimen.
Asunto(s)
Fiebre de Origen Desconocido/microbiología , Complejo Mycobacterium avium , Infección por Mycobacterium avium-intracellulare/complicaciones , Pancitopenia/microbiología , Adulto , Antituberculosos/uso terapéutico , Médula Ósea/microbiología , Femenino , Humanos , Infección por Mycobacterium avium-intracellulare/diagnóstico , Infección por Mycobacterium avium-intracellulare/tratamiento farmacológico , RecurrenciaRESUMEN
Leprosy is a chronic infectious disease with a wide spectrum of signs and symptoms depending on the ability of the host's immune system to resist the infection. The disease is frequently associated with sensory loss in skin lesions and damage in peripheral nerve trunks leading to nerve function impairment. In lepromatous leprosy, the immune system offers no protection against the multiplying bacilli and this results in heavy infiltration of the internal organs. We report a case of florid lepromatous leprosy with bone marrow suppression due to the disease, presenting with anemia, leukocytopenia and thrombocytopenia. The hematological abnormalities were fully reversed by mutidrug therapy for leprosy. We suggest that infiltration of the bone marrow by Mycobacterium leprae can cause pancytopenia, which can be cured by treatment of the leprosy alone.
Asunto(s)
Enfermedades de la Médula Ósea/sangre , Enfermedades de la Médula Ósea/microbiología , Leprostáticos/uso terapéutico , Lepra Lepromatosa/sangre , Pancitopenia/microbiología , Enfermedades de la Médula Ósea/patología , Extremidades/microbiología , Extremidades/patología , Cara/microbiología , Cara/patología , Humanos , Lepra Lepromatosa/tratamiento farmacológico , Lepra Lepromatosa/patología , Masculino , Pancitopenia/patología , Adulto JovenRESUMEN
Non-cirrhotic portal fibrosis, a common cause of splenomegaly in tropical countries, can lead to hypersplenism and pancytopenia. Hypersplenism in this setting has not been associated with opportunistic infections. We describe a patient with hypersplenism secondary to non-cirrhotic portal fibrosis who developed a Fonsecaea pedrosoi brain abscess and succumbed to the illness despite aggressive management.
Asunto(s)
Ascomicetos , Absceso Encefálico/complicaciones , Infecciones Fúngicas del Sistema Nervioso Central/complicaciones , Hiperesplenismo/complicaciones , Hígado/patología , Infecciones Oportunistas/complicaciones , Adulto , Femenino , Fibrosis/complicaciones , Humanos , Pancitopenia/microbiologíaRESUMEN
BACKGROUND: Disseminated histoplasmosis is a chronic granulomatous disease caused by the dimorphic fungus, Histoplasma capsulatum. Clinical presentation can vary from the acute pulmonary to the chronic disseminated form. In India, disseminated histoplasmosis often presents with pyrexia of unknown origin with a presentation similar to 'disseminated tuberculosis' involving the adrenal glands and bone marrow. Due to rarity of the disease, data are lacking regarding its clinical presentation and outcome among immunocompromised and immunocompetent patients. METHODS: During January 2000 to December 2010, we identified 37 patients of disseminated histoplasmosis and attempted to characterize the differences between immuno- compromised and immunocompetent patients. Demographic characteristics, clinical presentation, risk factors, laboratory findings, diagnostic yield, treatment received and prognosis were noted and compared between the two groups. RESULTS: Eleven of 37 patients with disseminated histo- plasmosis were immunocompromised and 26 were immuno- competent. Comparison of their clinical features showed a higher frequency of skin lesions in the immunocompromised compared to the immunocompetent group (54.5% v. 11.5%). Pancytopenia and anaemia were more common among the immunocompromised (81.8%) compared to the immunocompetent (46.2%) group. In the immuno- compromised patients, the diagnosis was made most often by bone marrow aspirate and culture (72.7%) compared to the immunocompromised group where the diagnosis was most often obtained by adrenal gland biopsy and fungal cultures (57.7%). The cure rate was significantly higher in the immunocompetent group (73% v. 45%). CONCLUSION: The clinical presentation and outcome of patients with disseminated histoplasmosis differs among immunocompromised and immunocompetent patients.
Asunto(s)
Glándulas Suprarrenales/patología , Médula Ósea/patología , Histoplasmosis/complicaciones , Histoplasmosis/diagnóstico , Inmunocompetencia , Huésped Inmunocomprometido , Adulto , Anemia/inmunología , Anemia/microbiología , Antifúngicos/uso terapéutico , Biopsia , Femenino , Histoplasmosis/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Pancitopenia/inmunología , Pancitopenia/microbiología , Enfermedades de la Piel/inmunología , Enfermedades de la Piel/microbiología , Resultado del TratamientoRESUMEN
La aspergilosis invasora es una causa importante de morbilidad y mortalidad en pacientes gravemente inmunodeficientes, especialmente en aquellos con neutropenia o receptores de trasplante de médula ósea o de órganos sólidos. Informamos sobre una hialohifomicosis esplénica morfológicamente sugestiva de ser causada por Aspergillus spp. en un paciente de 22 años de edad con anemia aplásica, tratado con múltiples transfusiones y antibióticos de amplio espectro(AU)
Invasive aspergillosis is an important cause of morbidity and mortality in severely immunocompromised patients, especially those who are neutropenic or who have undergone bone marrow or solid-organ transplant. We report a case of hyalohyphomycosis morphologically suggestive of an Aspergillus spp. in a 22-year-old patient with aplastic anaemia, treated with multiple transfusions and broad spectrum antibiotics(AU)
Asunto(s)
Humanos , Masculino , Adulto , Anemia Aplásica/complicaciones , Anemia Aplásica/patología , Aspergillus/aislamiento & purificación , Aspergillus/patogenicidad , Pancitopenia/microbiología , Granuloma/complicaciones , Factores de Riesgo , Indicadores de Morbimortalidad , Necrosis/diagnóstico , Necrosis/microbiología , Bazo/anatomía & histología , Bazo/microbiología , Bazo/patología , Enfermedades del Bazo/microbiología , Derrame Pleural/complicacionesRESUMEN
Brucellosis remains a diagnostic puzzle. We retrospectively studied the case notes of 105 patients with brucellosis who were admitted in the Department of Internal Medicine of the University of Patras Hospital, a tertiary care institution serving an extended rural area in western Greece, from 2003 to 2006. Five unusual causes of brucellosis were identified: hepatic, epidural and thyroid abscesses, intrahepatic cholestatic liver disease and pancytopenia. Virtually every human organ and system can be involved in brucellosis, which highlights the need to include brucellosis in the differential diagnosis, especially in endemic areas.