Miliary tuberculosis associated with chronic neutrophilic leukemia.
We report a case of miliary tuberculosis associated with chronic neutrophilic leukemia (CNL). A 70-year-old woman was referred to our hospital complaining of a 1-month history of persistent fever and anorexia. Chest and abdominal computed tomography images revealed diffuse small nodular lesions in the bilateral lung fields and extreme splenomegaly. Sputum cultures isolated Mycobacterium tuberculosis. After anti-tuberculous therapy for 1 year, the patient underwent splenectomy for massive splenomegaly and progressive leukocytosis. The presence of the homozygous JAK2 V617F tyrosine kinase mutation was also demonstrated in the peripheral blood. She was finally diagnosed as having miliary tuberculosis associated with CNL based on the histopathological examination of spleen. The patient was treated with a daily dose of 500 mg of hydroxyurea. As a result, 18 months after the splenectomy, her leukocyte count was decreased and her clinical condition was markedly improved; there was no relapse of the CNL.
Sugino
Keishi
K
Division of Respiratory Medicine, Toho University Omori Medical Center, Tokyo. keishi_sugino@ybb.ne.jp
Gocho
Kyoko
K
Ota
Hiroki
H
Kobayashi
Minaho
M
Sano
Go
G
Isobe
Kazutoshi
K
Takai
Yujiro
Y
Izumi
Haruka
H
Kuraishi
Yasunobu
Y
Shibuya
Kazutoshi
K
Homma
Sakae
S
D000368:Aged; D001853:Bone Marrow / Q000473:pathology; D005260:Female; D006720:Homozygote; D006801:Humans; D053614:Janus Kinase 2 / Q000235:genetics; D015467:Leukemia, Neutrophilic, Chronic / Q000150:complications* / Q000175:diagnosis* / Q000201:enzymology / Q000235:genetics; D020125:Mutation, Missense; D013154:Spleen / Q000473:pathology; D014057:Tomography, X-Ray Computed; D014391:Tuberculosis, Miliary / Q000150:complications* / Q000175:diagnosis*; D014400:Tuberculosis, Splenic / Q000150:complications / Q000175:diagnosis
C507924:JAK2 protein, human; D053614:Janus Kinase 2