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Mycobacterium tuberculosis of bone marrow that is considered one of the rare extrapulmonary tuberculosis (TB). Herein we report one case of tuberculosis of the bone marrow. A 82-year-old Thai woman presented with fever, fatigue, and weight loss of 4 kg in one month. The physical examination revealed only pallor and the ejection murmur at the upper parasternal border. Her chest film was unremarkable but the computed tomography of the chest revealed the reticular infiltration at both lower lungs and multiple small mediastinal lymphadenopathies. Although her blood smear did not show the leukoerythroblastic blood picture with the tear drop red blood cells (RBCs) or pancytopenia, her bone marrow biopsy showed a few granulomas with positive acid fast bacilli (AFB). The common risk factors such as diabetes, human immunodeficiency virus (HIV) infection, low CD4 counts, chronic kidney disease, malnutrition, and immunosuppressant therapy which might contribute her to be vulnerable to TB, were not found. The definite diagnosis was TB in the bone marrow and she clinically responded well to the 4-drug antituberculous regimen. Our case suggests that even though the leukoerythroblastosis with the tear drop RBCs or pancytopenia, the clues of the bone marrow involvement, is not found, the study of the bone marrow should not be precluded from the plan of the investigations for the diagnosis in a case of fever of unknown origin.
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2. Lin JN, Lai CH, Chen YH, et al. Risk factors for extra-pulmonary tuberculosis compared to pulmonary tuberculosis. Int J Tuberc Lung Dis. 2009;13(5):620-625.
3. Sreeramareddy CT, Panduru KV, Verma SC, Joshi HS, Bates MN. Comparison of pulmonary and extrapulmonary tuberculosis in Nepal- a hospital-based retrospective study. BMC Infect Dis. 2008;8:8. doi:10.1186/1471-2334-8-8.
4. Liu S, Chen W, Liu W. Diagnosis and treatment of tuberculosis of bone marrow. Zhonghua Jie He He Hu Xi Za Zhi. 1998;21(9):559-561.
5. Tongyoo S, Vilaichone W, Sukpanichnant S, et al. Thrombocytopenic purpura associated with miliary tuberculosis. J Med Assoc Thai. 2003;86(10):976-980.
6. Grewal R, Abayomi EA. Bone marrow morphological features and diagnostic value in paediatric disseminated tuberculosis in the setting of increased HIV prevalence. S Afr Med J. 2013;103(5):326-329.
7. Lombard EH, Victor T, Jordaan A, van Helden PD. The detection of Mycobacterium tuberculosis in bone marrow aspirate using the polymerase chain reaction. Tuber Lung Dis. 1994;75(1):65-69. doi:10.1016/0962-8479(94)90106-6.
8. Hakawi AM, Alrajhi AA. Tuberculosis of the bone marrow: clinico-pathological study of 22 cases from Saudi Arabia. Int J Tuberc Lung Dis. 2006;10(9):1041-1044.
9. Lin SH, Lai CC, Huang SH, Hung CC, Hsueh PR. Mycobacterial bone marrow infections at a medical centre in Taiwan, 2001-2009. Epidemiol Infect. 2014;142(7):1524-1532. doi:10.1017/S0950268813002707.
10. Al-Aska A, Al-Anazi AR, Al-Subaei SS, et al. CD4+ T-lymphopenia in HIV negative tuberculous patients at King Khalid University Hospital in Riyadh, Saudi Arabia. Eur J Med Res. 2011;16(6):285-288. doi:10.1186/2047-783X-16-6-285.
11. Avasthi R, Chaudhary SC, Ankur, Khan NP, Gupta A. Bleeding manifestations and pancytopenia secondary to bone marrow infiltration in tuberculosis. JIACM. 2008;9(4):316-318.
12. Olaniyi JA, Aken'Ova YA. Bone marrow findings in patients with pulmonary tuberculosis. Afr J Med Med Sci. 2003;32(2):155-157.
13. Kinoshita M, Ichikawa Y, Koga H, Sumita S, Oizumi K. Re-evaluation of bone marrow aspiration in the diagnosis of miliary tuberculosis. Chest. 1994;106(3):690-692. doi:10.1378/chest.106.3.690.
14. Singh UB, Bhanu NV, Suresh VN, Arora J, Rana T, Seth P. Utility of polymerase chain reaction in diagnosis of tuberculosis from samples of bone marrow aspirate. Am J Trop Med Hyg. 2006;75(5):960-963.
15. Reddy VB, Prchal JT. Chapter 45: Anemia Associated with Marrow Infiltration. In: Kaushansky K, Lichtman MA, Prchal JT, Levi MM, Press OW, Burns LJ, Caligiuri M, eds. Williams Hematology. 9th ed. New York, NY: McGraw-Hill; 2010:658-661.
16. D’Angelo G, Hotz AM. Myelophthisis in breast cancer. Am J Hematol. 2011;86(1):70-71. doi:10.1002/ajh.21927.