title: Miliary tuberculosis with no pulmonary involvement in myelodysplastic syndromes: a curable, yet rarely diagnosed, disease: case report and review of the literature.
abstract: BACKGROUND
  Although tuberculosis is not uncommon among patients with myelodysplastic syndrome (MDS), only a few reports of such patients suffering from miliary tuberculosis (MT) exist. MT often presents as a fever of unknown origin and it is a curable disease, yet fatal if left untreated.
  
  
  METHODS
  We report a case of MT with no clinical or laboratory indications of pulmonary involvement in a patient with MDS, and review the relevant literature. Mycobacterium tuberculosis was isolated from the liquid culture of a bone marrow aspirate.
  
  
  CONCLUSIONS
  Even if the initial diagnostic investigation for a fever of obscure etiology is negative, MT should not be excluded from the differential diagnosis list. Since it is a curable disease, persistent and vigorous diagnostic efforts are warranted. In suspected cases, mycobacterial blood cultures should be collected as soon as possible after hospital admission and early bone marrow aspirate with mycobacterial cultures is advocated.
authors.affiliation: Mycobacteriology Laboratory, Department of Clinical Bacteriology, Parasitology, Zoonoses and Geographical Medicine, University Hospital of Heraklion, Voutes, 71201 Heraklion, Greece. ineonakis@gmail.com
authors.forename: Ioannis K
authors.initials: IK
authors.lastname: Neonakis
authors.forename: Michael G
authors.initials: MG
authors.lastname: Alexandrakis
authors.forename: Zoe
authors.initials: Z
authors.lastname: Gitti
authors.forename: George
authors.initials: G
authors.lastname: Tsirakis
authors.forename: Elias
authors.initials: E
authors.lastname: Krambovitis
authors.forename: Demetrios A
authors.initials: DA
authors.lastname: Spandidos
mesh_terms: D001853:Bone Marrow / Q000382:microbiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009164:Mycobacterium Infections / Q000175:diagnosis* / Q000188:drug therapy; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D009190:Myelodysplastic Syndromes / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology; D015898:Tomography Scanners, X-Ray Computed; D014391:Tuberculosis, Miliary / Q000175:diagnosis* / Q000188:drug therapy