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Myelofibrosis Secondary to Tuberculosis
Chest Infections SESSION TITLE: Chest Infections I SESSION TYPE: Case Report Poster PRESENTED ON: Sunday, April 17, 2016 at 11:45 AM - 12:45 PM
Myelofibrosis Secondary to Tuberculosis Xianwei Ye MD* Zankun Jin MMSc; and Xiangyan Zhang MMSc Department of Respiratory Medicine, The People’s Hospital of Guizhou Province, Guiyang, China INTRODUCTION: Myelofibrosis (MF) is a hematological disorder characterized by progressive anemia, bone marrow fibrosis, hypercellularity, excessive deposits of extracellular matrix, extramedullary hematopoiesis with splenomegaly.[1]. In most cases that have been published, patients with tuberculosis existed preexisting chronic myeloproliferative disorders associated with myelofibrosis[2], we here present a rare case that a reversible myelofibrosis happened due to the tuberculosis. CASE PRESENTATION: A 54 year old man had repeated fever, chronic cough, sweating and general pain for over 20 days. He had a history of pulmonary tuberculosis a year ago, and ceased the drug therapy after a month. He had no underlying debilitating disorders. The patient had a fever of 38.5 C, with a left supraclavicular lymph node enlargement (1.0 cm in diameter) and a sternal tenderness. Routine blood tests showed severe anemia repeatedly (HGB:50-60g/L). Marrow cytology showed anemia and nucleated cell proliferation activity and obviously increased neutrophils ratio (about 78%). BM biopsy sections showed myelofibrosis. Diffuse miliary nodules in both lung and multiple lymphadenopathies in hilar lymphatic nodules were detected on Chest CT. Other examinations were negative. We gave the patient a combination therapy of isoniazid, rifampicin, pyrazinamide, and ethambutol. 10 days later, the patient’s imaging changes had improved, with resolution of general pain, fever and cough. About 4 months later, his bone marrow biopsy did not showed myelofibrosis anymore.
CHEST INFECTIONS
DISCUSSION: Myelofibrosis, with well-characterized malignant or benign diseases of hematopoietic or non-hematopoietic origin, is considered to be a secondary disorder. Tuberculosis is reported frequently to raise the possibility of myelofibrosis among non-hematopoietic diseases[3,4]. The association between myeloproliferative disorders and tuberculosis has been paid more attentions in hospitalized patients with preexisting chronic myeloproliferative disorders[2]. In our case, the patient had no preexisting chronic myeloproliferative disorder. Chemotherapy not only relieved severe anemia but also improved the function of bone marrow, no myelofibrosis existed after treatment. CONCLUSIONS: Infections like tuberculosis can induce meolyfibrosis as a complication. Testing for tuberculosis should always been considered for patient with myelofibrosis. Reference #1: Le Bousse-Kerdiles MC, et al. Myelofibrosis: pathogenesis of myelofibrosis with myeloid metaplasia. Springer Semin Immunopathol 1999;21:491-508. Reference #2: Dhamija RK, et al. Myelofibrosis with myeloid metaplasia due to tuberculosis. J Assoc Physicians India. 1998;46(4):394. Reference #3: Sohn MH, et al. Unusual bone scintigraphic findings of secondary myelofibrosis associated with disseminated tuberculosis before and after therapy. Clin Nucl Med. 2004;29(11):706-8. Reference #4: Dyke SC. Some cases of aleukia or aplastic anaemia associated with thrombopaenia. Lancet.1924;1:1048-51. DISCLOSURE: The following authors have nothing to disclose: Xianwei Ye, Zankun Jin, Xiangyan Zhang No Product/Research Disclosure Information DOI:
http://dx.doi.org/10.1016/j.chest.2016.02.115
Copyright ª 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
110A
[
149#4S CHEST APRIL 2016
]
Myelofibrosis Secondary to Tuberculosis Xianwei Ye MD* Zankun Jin MMSc; and Xiangyan Zhang MMSc Department of Respiratory Medicine, The People’s Hospital of Guizhou Province, Guiyang, China INTRODUCTION: Myelofibrosis (MF) is a hematological disorder characterized by progressive anemia, bone marrow fibrosis, hypercellularity, excessive deposits of extracellular matrix, extramedullary hematopoiesis with splenomegaly.[1]. In most cases that have been published, patients with tuberculosis existed preexisting chronic myeloproliferative disorders associated with myelofibrosis[2], we here present a rare case that a reversible myelofibrosis happened due to the tuberculosis. CASE PRESENTATION: A 54 year old man had repeated fever, chronic cough, sweating and general pain for over 20 days. He had a history of pulmonary tuberculosis a year ago, and ceased the drug therapy after a month. He had no underlying debilitating disorders. The patient had a fever of 38.5 C, with a left supraclavicular lymph node enlargement (1.0 cm in diameter) and a sternal tenderness. Routine blood tests showed severe anemia repeatedly (HGB:50-60g/L). Marrow cytology showed anemia and nucleated cell proliferation activity and obviously increased neutrophils ratio (about 78%). BM biopsy sections showed myelofibrosis. Diffuse miliary nodules in both lung and multiple lymphadenopathies in hilar lymphatic nodules were detected on Chest CT. Other examinations were negative. We gave the patient a combination therapy of isoniazid, rifampicin, pyrazinamide, and ethambutol. 10 days later, the patient’s imaging changes had improved, with resolution of general pain, fever and cough. About 4 months later, his bone marrow biopsy did not showed myelofibrosis anymore.
CHEST INFECTIONS
DISCUSSION: Myelofibrosis, with well-characterized malignant or benign diseases of hematopoietic or non-hematopoietic origin, is considered to be a secondary disorder. Tuberculosis is reported frequently to raise the possibility of myelofibrosis among non-hematopoietic diseases[3,4]. The association between myeloproliferative disorders and tuberculosis has been paid more attentions in hospitalized patients with preexisting chronic myeloproliferative disorders[2]. In our case, the patient had no preexisting chronic myeloproliferative disorder. Chemotherapy not only relieved severe anemia but also improved the function of bone marrow, no myelofibrosis existed after treatment. CONCLUSIONS: Infections like tuberculosis can induce meolyfibrosis as a complication. Testing for tuberculosis should always been considered for patient with myelofibrosis. Reference #1: Le Bousse-Kerdiles MC, et al. Myelofibrosis: pathogenesis of myelofibrosis with myeloid metaplasia. Springer Semin Immunopathol 1999;21:491-508. Reference #2: Dhamija RK, et al. Myelofibrosis with myeloid metaplasia due to tuberculosis. J Assoc Physicians India. 1998;46(4):394. Reference #3: Sohn MH, et al. Unusual bone scintigraphic findings of secondary myelofibrosis associated with disseminated tuberculosis before and after therapy. Clin Nucl Med. 2004;29(11):706-8. Reference #4: Dyke SC. Some cases of aleukia or aplastic anaemia associated with thrombopaenia. Lancet.1924;1:1048-51. DISCLOSURE: The following authors have nothing to disclose: Xianwei Ye, Zankun Jin, Xiangyan Zhang No Product/Research Disclosure Information DOI:
http://dx.doi.org/10.1016/j.chest.2016.02.115
Copyright ª 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
110A
[
149#4S CHEST APRIL 2016
]