Miliary tuberculosis with no pulmonary involvement in myelodysplastic syndromes: a curable, yet rarely diagnosed, disease: case report and review of the literature

Ioannis K Neonakis¹ , Michael G Alexandrakis² , Zoe Gitti¹ , George Tsirakis² , Elias Krambovitis³ and Demetrios A Spandidos¹

¹Mycobacteriology Laboratory, Department of Clinical Bacteriology, Parasitology, Zoonoses and Geographical Medicine, University Hospital of Heraklion, Voutes, 71201 Heraklion, Greece

²Department of Hematology, University Hospital of Heraklion, Voutes, 71201 Heraklion, Greece

³Microbiology and Parasitology Laboratory, Department of Veterinary Medicine, School of Health Sciences, University of Thessaly, 224 Trikalon Str., 43100 Karditsa, Greece

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Annals of Clinical Microbiology and Antimicrobials 2008, 7:8doi:10.1186/1476-0711-7-8


Published:	13 March 2008

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.

Case presentation

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.

Conclusion

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.