title: Disseminated tuberculosis presenting as multiple hepatosplenic microabscesses and pancytopenia in a teenage boy.
abstract: Disseminated tuberculosis usually occurs in immunocompromised hosts. Involvement of bone marrow, liver, and spleen is infrequent. A previously healthy 15-year-old boy presented with body weight loss, prolonged fever, neck lymphadenopathy, pancytopenia, and hepatosplenic microabscesses within the recent month and was transferred to our hospital. Bone marrow studies showed hypocellular marrow. Based on his clinical manifestations, hemophagocytic syndrome was initially suspected. Pancytopenia resolved after administration of intravenous immunoglobulin but caseous necrosis and/or positive acid-fast stain were subsequently demonstrated in the lymph node biopsy and sputum. Cultures from these 2 specimens grew Mycobacterium tuberculosis. Fever continued in a low-grade pattern even under antituberculous therapy with rifampin, isoniazid, pyrazinamide and ethambutol. Five months after admission, fever subsided after splenectomy and liver wedge resection. Microscopic examinations of both the liver and spleen showed mycobacteria-related granulomatous inflammation and caseating necrosis. This report suggests that tuberculosis infection should be considered in the differential diagnosis in patients with prolonged fever, pancytopenia and hepatosplenic abscesses.
authors.affiliation: Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Chien-Han
authors.initials: CH
authors.lastname: Chen
authors.forename: Yin-Hua
authors.initials: YH
authors.lastname: Fang
authors.forename: Po-Min
authors.initials: PM
authors.lastname: Chiang
authors.forename: Dong-Tsamn
authors.initials: DT
authors.lastname: Lin
authors.forename: Li-Min
authors.initials: LM
authors.lastname: Huang
mesh_terms: D000038:Abscess / Q000382:microbiology*; D000293:Adolescent; D006801:Humans; D008100:Liver Abscess / Q000382:microbiology*; D008297:Male; D010198:Pancytopenia / Q000382:microbiology*; D013158:Splenic Diseases / Q000382:microbiology*; D014376:Tuberculosis / Q000175:diagnosis*