In Tuberculosis -Uncommon Presentation of a Common Disease

We present here a case report of a 27 year old man, who presented with high grade fever and swelling in the neck region. Peripheral blood smear showed both normocytic normochomic as well as microcytic hypochromic blood picture. Hemoglobin was 6.2 g%, TLC was 2100/mm3, DLC was: L65, N30, E05, platelet count was 69000 (i.e. pancytopenia was documented). FNAC of the cervical lymph nodes revealed reactive hyperplasia, with no evidence of caseating or non-caseating granulomas. A differential diagnosis of aplastic anemia was made. However, bone marrow examination revealed acid fast bacilli (AFB) on ZN staining. A revised diagnosis of bone marrow tuberculosis was made and the patient was put on ATT. There was a dramatic response clinically and thepancytopenia reverted after treatment.