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November 28, 1980

Bone Marrow Necrosis From Miliary Tuberculosis

Author Affiliations

From the Sections of Hematology (Dr Katzen) and Pulmonary Diseases (Dr Spagnolo), Medical Service, Veterans Administration Medical Center, Washington, DC; and the Division of Pulmonary Diseases, Department of Medicine (Dr Spagnolo), George Washington University School of Medicine and Health Sciences, Washington, DC.

JAMA. 1980;244(21):2438-2439. doi:10.1001/jama.1980.03310210040024

ALTHOUGH anemia and leukopenia are not unusual with tuberculosis, pancytopenia is rare.1,2 When pancytopenia does occur, it is usually due to an underlying primary hematologic disorder and is almost always fatal.3,4

Report of a Case  A 36-year-old man was admitted to the hospital complaining of fever, chills, and night sweats of four weeks' duration. He had a mild, nonproductive cough and appeared acutely ill and tremulous. His temperature was 39.8°C; pulse rate, 108 beats per minute, and blood pressure, 110/70 mm Hg. A 4-cm diameter supraclavicular lymph node was easily palpable. The chest was clear to auscultation. Total liver span was 20 cm. The spleen could not be felt.Laboratory studies disclosed the following: hematocrit level, 25%; WBC count, 2,800/μL; and differential cell count: 52% segmented neutrophils, 23% band forms, 21% lymphocytes, 1% eosinophils, 1% monocytes, and 2% metamyelocytes. The platelet count was 327,000/μL. His chest