Extrapulmonary tuberculosis (TB) involving bone marrow can present with various manifestations, including pancytopenia, maturation arrest, hemophagocytic lymphohistiocytosis (HLH), or infiltration of the bone marrow by caseating or noncaseating granulomas causing reversible or irreversible fibrosis. Tumor lysis syndrome (TLS) is an oncologic emergency resulting from massive tumor cell lysis. Children with TB with bone marrow involvement may also present with laboratory features of TLS resulting from high catabolism and concomitant acute kidney injury (AKI), making the diagnosis difficult at times. We present a case of disseminated TB who presented to emergency with pancytopenia, AKI, and laboratory features of TLS.
Avasthi R, Mohanty D, Chaudhary SC, Mishra K. Disseminated tuberculosis: interesting hematological observations. J Assoc Physicians India 2010;58(4):243–244.
Abu-Alfa AK, Younes A. Tumor lysis syndrome and acute kidney injury: evaluation, prevention, and management. Am J Kidney Dis 2010;55(Suppl 3):S1–S13. DOI: 10.1053/j.ajkd.2009.10.056.
Cairo MS, Coiffier B, Reiter A, Younes A. Recommendations for the evaluation of risk and prophylaxis of tumor lysis syndrome (TLS) in adults and children with malignant diseases: an expert TLS panel consensus. Br J Haematol 2010;149(4):578–586. DOI: 10.1111/j.1365-2141.2010.08143.x.
Singh KJ, Ahluwalia G, Sharma SK, Saxena R, Chaudhary VP, Anant M. Significance of hematological manifestations in patients with tuberculosis. J Assoc Physicians India 2001;49:788–794.
Le Hô H, Barbarot N, Desrues B. Pancytopenia in disseminated tuberculosis: think of macrophage activation syndrome. Rev Mal Respir 2010;27(3):257–260. DOI: 10.1016/j.rmr.2010.02.005.
Qasim ZA, Sarwari AR, Jilani SM. Treatment failure of tuberculosis due to concomitant pathology. J Pak Med Assoc 2003;53(8):367–369.
Hashim MS, Kordofani AY, el Dabi MA. Tuberculosis and myelofibrosis in children: a report. Ann Trop Paediatr 1997;17(1):61–65. DOI: 10.1080/02724936.1997.11747865.
Meneshian A, Bulkley GB. The physiology of endothelial xanthine oxidase: from urate catabolism to reperfusion injury to inflammatory signal transduction. Microcirculation 2002;9(3):161–175. DOI: 10.1038/sj.mn.7800136.
Feig DI, Kang D-H, Johnson RJ. Uric acid and cardiovascular risk. N Engl J Med 2008;359(17):1811–1821. DOI: 10.1056/NEJMra0800885.
MacKinnon KL, Molnar Z, Lowe D, Watson ID, Shearer E. Measures of total free radical activity in critically ill patients. Clin Biochem 1999;32(4):263–268. DOI: 10.1016/S0009-9120(98)00109-X.
Tsai K, Hsu TG, Kong CW, Lin K, Lu F. Is the endogenous peroxyl-radical scavenging capacity of plasma protective in systemic inflammatory disorders in humans. Free Radic Biol Med 2000;28(6):926–933. DOI: 10.1016/S0891-5849(00)00180-5.