PANCYTOPENIA ASSOCIATED WITH DISSEMINATED TUBERCULOSIS

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Abstract
A case is described in which pancytopenia was the presenting feature of concealed disseminated tuberculosis. Splenectomy was undertaken 4 weeks after chemotherapy [streptomycin and isoniazid] had commenced. Antituberculous therapy was continued, and one year later the patient was perfectly well, the liver not palpable, and the blood count normal. Sections of the spleen showed miliary tubercles. The mechanism of the blood dyscrasia is not very well understood. Both abnormal splenic function and marrow invasion have been held responsible. The pancytopenias have also been compared to other blood disorders found in disseminated tuberculosis, viz., leukemoid reactions, myelosclerosis and polycythemia vera, the common mechanism being the product of tubercle bacilli on an allergic haemopoietic system. The diagnosis is difficult, as positive evidence of tuberculosis is often lacking. A negative X-ray chest is common. Choroidal tubercles are infrequent. Marrow and liver biopsy have been used with varying success. The blood disorder might be so striking that the underlying disease is easily overlooked. If untreated the disease runs a rapid and fatal course. Early diagnosis is imperative so that appropriate treatment be promptly instituted. It is suggested that pancytopenia of obscure origin if associated with high fever and sweating, should bring this condition to mind, and even if positive proof of tuberculosis is lacking, antituberculous therapy should be started.